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 from our readers and the question last week was
You can check out last week’s episode by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer another question from one of our clients which is an excerpt from a 1:1 phone counselling and consulting session with me and the question this week is another case study!
CASE STUDY: My 77 year old Dad has been in ICU ventilated for a week and he’s not “waking up”! The doctors have made him NFR without my consent and they want to switch off the ventilator, help! (PART1)
This is another great case study where you can see how I can help a very concerned and very distressed client how to quickly make sense in a situation where the Intensive Care team hasn’t been open transparent with her and her family!
As a matter of fact, the Intensive Care team threatened to take her Dad off the ventilator by a certain date, without the client’s consent!
It’s also another great case study to show families in Intensive Care that you simply don’t know what you don’t know and that you getting informed quickly so that you can turn the dynamics in your favour is crucial!
If you do what 99% of the families of critically ill Patients in Intensive Care are doing you won’t do your own research and you will just silently nod off everything the Intensive Care team is telling you and you will continue to be intimidated by the “perceived power” and the “perceived authority” by Intensive Care team…
If you do that, you will not being able to make informed decisions, get peace of mind, control, power and influence…
As a matter of fact, if you don’t ask the right questions and if you are not arming yourself with crucial insider and “BEHIND THE SCENES” knowledge, your critically ill loved one and your family may be doomed!
In our case study with my client Denisa, you can see that only in one phone conversation I can empower her and show her what questions she needs to ask and I can also show her what information the Intensive Care team has been hiding!
It’s also another great case study how to counteract the negativity of the Intensive Care team, if you only know what questions you need to ask and if you can interpret information correctly!
The number one complaint we’re getting from families in Intensive Care is that Intensive Care teams are negative!
We know that and in our hundreds of “YOUR QUESTIONS ANSWERED” episodes and in our hundreds of case studies we always show our clients how to stay positive and how to position your critically ill loved one’s diagnosis, their prognosis as well as their care and their treatment in a light that doesn’t allow Intensive Care teams to be negative!
This is also another great CASE STUDY how we can help our clients to not only get the best care and treatment possible for their critically ill loved one, it’s also a great CASE STUDY how we can predictably help families in Intensive Care to reverse an NFR(=not for resuscitation) order or a DNR(Do not resuscitate) order that was issues against their wishes and without their consent!
Because we know the hospital system and Intensive Care so well, we can get predictable results for you and for your critically ill loved one really quickly! We can help you position your critically ill loved one’s diagnosis and prognosis and therefore help you to get the best treatment for your critically ill loved one!
If you don’t know how to position your critically ill loved one’s prognosis and diagnosis, the Intensive Care team will do it for you and they do so with their own self-interest at top of their mind!
Enjoy the case study and enjoy the excerpt of the phone counselling and consulting sessions!
Denisa: I’m looking for advice about my father who is in intensive care on a ventilator.
Patrik: Yes. You’ve come to the right place.
Denisa: Oh good. Sorry, I’m a bit overwhelmed.
Denisa: He’s got emphysema and he’s been hospitalised a few times over the last couple of years for pneumonia. He was hospitalised on the seventh by ambulance. I saw him the next morning on the eighth and by then he was what’s the word? Disoriented in delirium which started after he went into hospital. They told me it was from an infection in his blood. From there they put him in ICU. They had him on a breathing machine. He was fighting having that on so he was shackled but he had it on. They were telling me they were considering putting him on a ventilator because of his behaviour but they ended up putting him on a ventilator because his breathing got really bad and I only found out recently he had a heart attack as well and to control his blood pressure. He has been on a ventilator now, this is day 13.
Last Saturday morning after being ventilated for two to three days, he is breathing on his own again. He has been from minimal support from a ventilator so they stopped sedatives last Saturday morning at 10 am and they’ve been unable to take him off of it because he’s not showing … they don’t think he’s conscious enough.
Patrik: No. Sorry. Go on. Go on.
Denisa: Sorry. Sorry. He’s been able to squeeze my hand’s when I’ve asked and he’s opened his eyes when I’ve asked but we had a meeting with the doctors yesterday and they are pushing, they are telling me that he isn’t responding at all. That it’s just natural responses he’s giving and pretty much they want to turn the ventilator off. But they have done an MRI and a CT scan of the brain and there is no reason that he’s not regaining consciousness.
Even after the family meeting yesterday, they are really pushing for us to do a do not resuscitate order which I’ve done.
Patrik: You have?
Denisa: Yes. When my dad first went in and he was coherent, he verbally told them he didn’t want that.
Patrik: Okay. Okay. Fair enough.
Denisa: My auntie then told them because like I said the circumstances have changed, that she wanted him resuscitated and the last few days have been better. I rang the nurse this morning and the nurses told me he had opened his eyes when they’ve asked. They kept telling us different things but they are telling us now he’s not ever going to be responsive but he sort of is.
Patrik: How old is your dad?
Denisa: He’s 77.
Patrik: Okay that, I mean you know that’s, I tend to ask, I’ve seen all sorts of ages in ICU from teenagers to 90 plus. People recover no matter how old they are. You were talking about your auntie a moment ago. Who is the decision maker? Who is the next of kin? Is it you? Is it your auntie? Who’s the next of kin?
Denisa: It’s me.
Patrik: It’s you?
Denisa: It’s been handed over to me. Yes.
Patrik: Okay. Okay. Right. So, here is what I can see from everything that you have told me so far. The number one thing that stands out to me is that they’ve done the CT and the MRI and they are telling you he’s never going to wake up but they, from what I understood and correct me if I’m wrong, from what I’ve understood there is no conclusive results in the CT and the MRI that confirms that he will never wake up.
Patrik: Is that correct?
Denisa: Yes. They won’t do a lumbar puncture because he had random bleeding in his leg and they said random bleeding in the back of his head. That was the first I’ve heard of that.
Patrik: What do they mean with the random bleeding on the back of his head? Is that external or internal in the brain, the bleeding?
Denisa: I actually didn’t ask them at the time because I was a bit hysterical about what they were saying but they did say it was a possibility of him waking up but they kept pretty much saying his quality of life is reducing, because of the ventilator which I understand but they also sedated him again a few days after they took him off sedation, they sedated him again one night. I don’t understand why when he’s not, when they are thinking he’s not coming off the sedatives because he’s also showing renal failure as well.
Patrik: So here is what I can see Denisa just by everything you’re explaining to me. So, the CT of the brain and the MRI as far as I understand, there is no evidence that he has brain damage. Is that correct?
Denisa: Yes. That’s correct.
Patrik: Okay. So that’s number one. So brain damage has been ruled out. So number two, your dad has been on and off in an induced coma since the eighth of April. Is that correct?
Denisa: Yes. I think so. But last Saturday, I don’t know the date of that sorry, they stopped all sedation because he had been, he’s breathing only with the ventilator helping with pressure. I think when he’s breathing out? I think that’s correct. I think.
Patrik: But he has been on and off in an induced coma for the last 13 days let’s just say. So, number one what I would want to know is what sedation have they been giving because there is a big difference. Depending on what they’ve given, it can take a lot longer to come out of an induced coma depending on what medications they’ve used. That’s number one. Number two is with increasing age, it’s taking longer to get out of an induced coma. Okay? As a rule of thumb. I’d say anybody above 65, it takes a lot longer to come out of an induced coma. So from my perspective, your dad needs time and they don’t want to give him the time and the reality is that all ICUs are under pressure for beds, right?
So the biggest problem an ICU has and I’m going away from patient care for a moment so just that you understand the bigger picture, the biggest problem an ICU has is that Patients occupy beds forever and a day. That’s their biggest problem, okay? They are trying to tell you yeah your dad won’t have any quality of life. He’s never going to come out of this. Now, I have no crystal ball. But most of the time, that’s a whole load of crap. They need to give your dad time. Now the argument of quality of life, they are talking about a perception? I don’t know what your dad would accept for quality of life. I don’t know that. You may and that’s fine. But they certainly know what your dad would accept for quality of life for the future. They certainly don’t. They are making an assumption based on what they see in intensive care.
Now the reality is that nobody in intensive care, not a doctor, not a nurse, knows what the life of an intensive care survivor looks like in six months time, in 12 months time. They have no idea. I’ve worked in ICUs for nearly 20 years. Most people survive ICU but I have no idea what people’s lives look like in six months time, in 12 months time. I would love to. But the reality is they don’t know it either. So they are talking about quality of life without even knowing what it means for a person because there is no…
Denisa: I don’t know. I feel restless about everything because it’s not like he’s moving a lot or anything but he is responsive to me speaking to him not just touching. He’s moving his head a tiny bit each way he’s opening his jaw a little bit, opening his eyes a tiny bit but he does it when I’m talking to him.
Patrik: So that’s a good sign. You know? I tell you what I can see as well and I could be wrong there but I tell you and that’s really where we are getting to the details. Okay let’s just say that somebody is going to be in an induced coma up to, let’s just say three or four days maybe five days, they are getting medications that are short acting and that means as soon as you take patients out of an induced coma they should wake up relatively quickly. Now if a coma goes on for more than five days, they often change to different medications which is long acting.
Denisa: Sorry, I cut you off. They told me they had him on two different sedatives.
Patrik: Yup and the other one …
Denisa: I can’t remember the other one exactly.
Patrik: Midazolam. (Versed)
Patrik: The other one would be Midazolam(Versed). So Propofol is the short acting sedative and that’s when people wake up they often wake up within a half an hour even after high doses because it’s short acting.
Now the long acting sedative is Midazolam and I’m pretty sure that they’ve switched from Propofol to Midazolam at some point. Now, the Midazolam is a good sedative but it can take ages for people to come out of it. Given that the MRI has ruled out brain damage, I argue that the reason why your dad is not waking up is the Midazolam is still in his system. Right? Number two. There is another factor. Number two, on top of the Midazolam or the Propofol, he would have also been given some Morphine or some Fentanyl.
Denisa: I think Morphine. I think he gets definitely Morphine.
Patrik: So the Morphine, it’s a very good pain killer but it’s also very strong and similar to the Midazolam it takes ages to get out of the system especially now … have you mentioned earlier that your dad is in renal failure? In kidney failure?
Denisa: Yes. I think that started in hospital as well but yes he is.
Patrik: Have they got him on Dialysis?
Denisa: They are only starting him on Dialysis tonight.
Patrik: Okay. Okay. That I see is a good sign. The reason for that is if his kidneys are failing, there is a good chance that if they are starting dialysis, that they can rid of the some of the drugs that are still floating around in his system and that might help him to wake up. It might.
Denisa: Okay. Okay. That’s a good thing to hear.
Patrik: Because if his kidneys are failing, he’s not excreting all the medications he’s had over the last almost two weeks. Right? They are not telling you that because they think people don’t understand or they are just too busy. They don’t like to talk to people. I know how they operate.
Denisa: Yeah, okay. It’s getting told different things to like he’s not going to respond mentally and then hearing he is responding.
Patrik: I’m not surprised.
Denisa: They’ve told me they will keep him ventilated until the 27th if I want but by then they don’t want to put in a tracheostomy …
Patrik: A tracheostomy? Why not?
Denisa: They haven’t really told me but I don’t think they actually gave me a reason.
Patrik: You’ve got to ask.
Denisa: Sorry I was in a little bit of shock when I heard this.
Patrik: So 27th. So today is the 21st. That’s another six days.
Denisa: They said that because that would be three weeks of him being ventilated.
This is PART 1 of the
CASE STUDY: My 77 year old Dad has been in ICU ventilated for a week and he’s not “waking up”! The doctors have made him NFR without my consent and they want to switch off the ventilator, help! (PART1)
Tune in PART 2 of our case study, it’ll come out in a few days where I’ll show Denisa how she needs to position her Dad’s diagnosis, his prognosis as well as his care and his treatment so that she can get what she wants, needs and deserves!
And most of all I help Denisa how she can take the NFR(Not for resuscitation) order off her Dad so that he’s in the best position to get out of Intensive Care alive!
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Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below! In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care! In your FREE report you’ll also discover
- 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
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 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
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care (it’s not what you think)
Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
Or you can call us! Find phone numbers on our contact tab.
Also check out our Ebook section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 counselling/consulting with me via Skype, over the phone or via email by clicking on the products tab!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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