My 73 year old Mom had a stroke and is intubated in Intensive Care. She can’t come off the ventilator and the breathing tube, can she have a tracheostomy and go home and have INTENSIVE CARE AT HOME? (PART 4)

Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question in this series of questions from one of my clients Steve and the question last week was PART 3 of

My 73 year old Mom had a stroke and is intubated in Intensive Care. She can’t come off the ventilator and the breathing tube, can she have a tracheostomy and go home and have INTENSIVE CARE AT HOME? (PART 3)

You can check out last week’s episode by clicking on the link here.

You can also find PART 1, PART 2 and Part 3 here

In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer another question from one of my clients Steve, which are excerpts from phone and email counselling and consulting sessions with me and the question this week is

Steve continues with his mother’s situation below

Hi Patrik,

My mother was doing very well and resumed eating food and we were just waiting for a bed in the neuro rehab centre (her private insurance would only cover her for 2 weeks rehab). Unfortunately last night she suffered a cardiac arrest and apparently there has been a prolonged period with no oxygen to her brain. She was resuscitated for 8 minutes but is now in a natural coma and mostly unresponsive.

The doctors have said that 96 hours is the “magic” number and we would need to see improvement in her conscious state or beyond that it will be quite hopeless. If there is any light you can shed around this it would be much appreciated as always.

As always, having full knowledge helps and you are really knowledgeable and you know your stuff! I’m not sure about cooling therapy I will ask. She has a high temperature so they are trying to keep her cool. Her limbs are very cool to touch.

She is booked in to do a CT scan and they said they generally do an MRI on day 3. At the moment they say it’s just about time and see what happens over the next 24 hours. They’ve administered antibiotics to deal with the infection in the lungs as she may have aspirated.

Beyond that she is heavily unconscious. Last time this happened (when she was unconscious and admitted back to ICU) she woke up as soon as the sedation wore off. I’ll update you and I know there’s not much that can be done but as always your information if you have any can help so many thanks.

We also just had a meeting with everyone. The doctors (neurologist and Intensivist) were pretty clear on the damage done to most of her brain, brain cells, from the MRI. There isn’t really a decision to be made just when enough family have come to pay their last visits would guide when they’d switch off the machines. They can’t say that she’s “brain dead“ as parts of her brain stem are still working. Her eyes flicker, she coughs spontaneously and jolts every now and then. Thought I’d speak to you first, just to see if we are missing anything but otherwise thanks for everything.

Many thanks

Steve

Recommended:

1:1 email counselling and consulting with Patrik

1:1 phone and email counselling and consulting with Patrik

Hi Steve,

cooling therapy after cardiac arrest should be standard therapy after cardiac arrest and a long “down time”. It’s to protect the brain and other major organs to minimise oxygen consumption.

It’s usually done for up to 72 hours and then Patients are being “woken up”. Temperature is usually being cooled down to 32-33.9 °C (90-93°F).

Not sure why they are not doing this in your mother’s situation. Sometimes it is ICU consultant dependent and sometimes they may argue it only needs to be done in an out of hospital cardiac arrest. Your mother’s cardiac arrest was in-hospital and therefore they may argue she had a faster response time to the cardiac arrest from the medical team.

Two things stand out to me and will most likely impact on the survival/recovery of your mother

Damage done to the heart

Potential brain damage

Yes, CT/MRI of the brain are often done are 72 hours but often after cooling therapy.

My advice for now with the limited information you’ve given me would be not to get pressured again to agree to anything you are not comfortable with, unless they are clear on the damage done to the heart and/or brain.

Related articles/videos:

What happens if my critically ill loved one had a period where they had insufficient oxygen supply to the brain? What is the prognosis after the brain has not had sufficient oxygen supply(hypoxic brain injury)

THE 10 THINGS YOU DIDN’T KNOW ABOUT SEVERE HEAD OR BRAIN INJURIES (INCLUDING TRAUMATIC BRAIN INJURY AND STROKE) IN INTENSIVE CARE THAT YOU MUST KNOW, ESPECIALLY IF YOUR CRITICALLY ILL LOVED ONE ISN’T WAKING UP OR IF THE INTENSIVE CARE TEAM IS SUGGESTING A POOR PROGNOSIS OR EVEN WORSE, IF THE INTENSIVE CARE TEAM SUGGESTS A “WITHDRAWAL OF TREATMENT” OR A “LIMITATION OF TREATMENT!

The next thing they should evaluate is the damage done to the heart and they can do that by doing an ultrasound/echocardiogram of the heart.

Even though you haven’t shared it, there is a very good chance your mother is on inotropes/vasopressors to maintain a physiological blood pressure and also to increase/maintain pump function of the heart(=contractility).

Your mother is most likely on inotropes/vasopressors such as Adrenaline(Epinephrine), Noradrenaline(Norepinephrine), Vasopressin, Dobutamine or Milrinone.

Even though there is a very high chance that your mother may not survive this set back since she left ICU a few days ago, you still don’t want to rush into making a “final” decision.

If your mother is not suffering- and you haven’t mentioned any of it- there is no reason to rush things.

The best thing that can happen is that your mother is going to improve and the worst thing that’s going to happen is that she may die, which is pretty much what the ICU team is predicting and in all honesty it looks that way.

You still want to do more research and you want to make sure that you and your family are at peace and in agreement with everything that’s happening.

For example, make sure your mother is in a “real” and not a “perceived” end of life situation.

How can you find out? Go and have a look here

The Difference Between “Real” And “Perceived” End Of Life Situations When Your Loved One Is Critically Ill In Intensive Care!

You don’t want to leave anything to chance- which you haven’t been doing anyway- and you certainly don’t want to leave any stones unturned before making a decision.

Next, you want to make sure at this stage that your mother is continuing to get full treatment until you and your family have made a decision what the next steps are.

What often happens in situations like this is that Intensive Care teams issue a DNR(Do not resuscitate) or NFR(Not for resuscitation) order.

They do this without informing you and quite frankly it’s illegal, however Intensive Care teams do it all the time, because their “hidden agenda” is way more important to them than it is talking to you and your family and they simply don’t want to be transparent in their decision making because of their hidden agenda!

What’s their “hidden agenda”? I’m glad you’ve asked, go and have a look here

INTENSIVE CARE’S HIDDEN SECRETS AND MYTHS BEHIND THE SCENES, THAT THE INTENSIVE CARE TEAM KEEPS AWAY FROM YOU AT ANY COST AND OTHER FAMILIES OF CRITICALLY ILL PATIENTS HAVE NO CLUE ABOUT THOSE HIDDEN SECRETS!

99% of families of critically ill Patients in Intensive Care have no idea that things like that are happening and that’s why it’s so important that you do your own research, that you question everything and that’s why you need to hire somebody like me who knows Intensive Care inside out and actually knows and understands what’s happening “BEHIND THE SCENES” in Intensive Care.

Most families in Intensive Care are shocked when I tell them the things they need to watch out for and they are shocked when they realize what unethical practices do happen in Intensive Care on a day by day basis in first world countries like the USA, Canada, the UK and Australia!

The good news is that with my strategies you can put a halt to it if you want to and you will be in a position to buy time for your mother if you want to, to see if she can recover.

Recommended:

THE 10 THINGS YOU DIDN’T KNOW ARE HAPPENINGBEHIND THE SCENES IN INTENSIVE CARE THAT HOLD YOU BACK FROM HAVING PEACE OF MIND, CONTROL, POWER AND INFLUENCE, WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!

THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO“LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT”, “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!

Also, there is no such thing as the “magic number” like 96 hours without response means your mother is going to die, that’s just a whole lot of BS.

The most important and the most precious resource is time and by “framing” your mother’s diagnosis, her prognosis as well as her care and her treatment in tight time frames, it’s clearly telling me that they don’t want to give her that time.

Many critically ill Patients recover if they are given time and clearly time is money in Intensive Care terms and most Intensive Care Units are trying to run a “tight ship” so to speak and they are trying to manage their financial budgets, their beds and the staffing resources. Those issues are often way more important compared to giving Patients the time and therefore chance to recover!

I have seen it all after nearly 20 years Intensive Care nursing experience in three different countries, where I literally looked after thousands of critically ill Patients and their families and where I also worked as a Nurse Unit Manager in Intensive Care for over 5 years.

And now with my own consultancy for families in Intensive Care I hear the same stories over and over again every single day and I know how to get outcomes and results for families and their loved ones in Intensive Care very quickly, because I know the system so well.

The “magic number of days” that critically ill Patients in Intensive Care need to recover is often unknown and that’s why Intensive Care teams tend to be so quick to suggest to “remove life support” or to “withdraw treatment” or to issue a “DNR”(Do not resuscitate) or “NFR”(Not for resuscitation) order most of the time against Patients and families wishes.

They often don’t want to use the time and resources(physical and emotional resources) that it takes to get your mother (or any other Patients) to improve!

Good for you that you have been challenging them from the start and the Intensive Care team knows by now that you are not a “push-over” like 99% of the families in Intensive Care.

You know that you have choice and you know how to get what you want by now because you have sought my counsel, consulting and advocacy.

I can’t tell you how many families in Intensive Care contact me and they believe that they have no choice whatsoever. They have a limited mindset, they are intimidated by the Intensive Care team and they don’t believe in themselves or in the advice that I can give them.

For now, keep waiting and don’t let the Intensive Care team push you to do anything you are not comfortable with. Time will tell you everything you need to know…

Yes, being in a natural coma after cardiac arrest and now being responsive is highly suggestive of significant brain damage and the prognosis for your mother doesn’t look good at this stage.

But it’s only been 48-72 hours since the cardiac arrest and therefore it’s way too early to make a life or death decision.

You see, one of the fallacies in Intensive Care is that doctors and nurses often only see Patients at their worst and quite frankly that is a lot to take in, even for the strongest and most seasoned Intensive Care professional.

The challenge is to move beyond it and look at what’s possible when patience is being applied.

Again, you will see in the next few days if brain damage is confirmed and if your mother isn’t “waking up” then there is a good chance she may die. Until this has been proven beyond the shadow of a doubt, let’s wait and see.

If it has been proven beyond the shadow of a doubt, you may still want other things that are important for you and for your family. Maybe you want her to die at home in peace rather than let her die in a hospital?

You mentioned INTENSIVE CARE AT HOME already and we can provide palliative care for your mother at home with INTENSIVE CARE AT HOME if you want to.

This provides a genuine alternative to letting your mother die in Intensive Care!

Best wishes

Patrik

How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?

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How to ask the doctors and the nurses the right questions

Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests

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5 mind blowing tips& strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation