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 shared another question in this series of questions from my client Veronica and the question last week was PART 11 of
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 the next question from one of my clients Veronica, which are excerpts from 1:1 phone and email counselling and consulting sessions with me and the question this week is
My Dad (71) is in ICU with stage 4 lung cancer & stroke, he’s on the ventilator now and in an induced coma, what are his chances of survival? (PART 12)
You can also find previous counselling and consulting sessions with Veronica here
my father started getting Midazolam(Versed) and Fentanyl since 2pm this afternoon and dad is still with us. I hope this is normal?
The Intensive Care doctors and nurses thought he would pass a lot sooner. I do not want him to suffer. Any advice? Comments please?
I’m by his side and can only text.
My father did not get to communicate with us after he came out of his induced coma as he was too week to speak and to write. He was able to nod to respond though.
He is a real fighter but I hope he is not suffering. My dad was very distressed yesterday as he was coming out of the sedation and did not want nurses near his neck where they were putting the sedatives.
He refused morphine for pain so we only had the fentanyl and midazolam(Versed) the doctors suggested to be administered. He is still with us is this ok? He is slowly, slowly letting go. Its after midnight now. I hope and pray he is not in pain.
your Dad is very lucky to have you there so you can be there for him in his final hours!
Fentanyl and Midazolam(Versed) are fine, it really depends on how much they are giving.
Have you got a dose? How much are they giving?
Fentanyl is very similar to Morphine, if not stronger and should manage any pain if given in adequate doses.
You see, in a situation like this, it’s a fine line between keeping your Dad comfortable and pain free and also not euthanise him. I have mentioned my concerns about the issue of euthanasia before.
Even though it is common practice to give Midazolam and Fentanyl or Morphine in end of life situations, it is again a fine line between keeping a Patient comfortable, minimise their suffering at the end of their life, without hastening death.
Some people might argue that strong sedation like Midazolam in high doses as well as high doses of strong pain killers/opioids like Fentanyl or Morphine might hasten death especially when Patients are not on life support.
I tend to agree that it hastens death, as I have seen those situations hundreds of times. Now, from my perspective, if Patients are in a “real” and not “perceived” end of life situation I am supportive of this approach.
- The Difference Between “Real” And “Perceived” End Of Life Situations When Your Loved One Is Critically Ill In Intensive Care!
I do have massive concerns if Patients are in a “perceived” end of life situation, get taken off life support and then get commenced on Midazolam and Fentanyl for end of life sedation. That in my mind is euthanasia and is clearly hastening death if other options haven’t been considered.
In your Dad’s situation, I think we can confidently say that he’s in a “real” end of life situation and we have left no stone unturned.
Also, if he was in pain I’m certain that you or the nurses could see it.
A normal dose of Fentanyl and Midazolam in an end of life situation would be up 50-150 micrograms/hr Fentanyl and between 5-20 milligram/hr Midazolam. In some rare sitautions, I have seen up to 300 micrograms/hr Fentanyl and up to 30 milligram/hr of Midazolam, plus the occasional Fentanyl or Midazolam bolus.
Therefore, time frames are hard to predict.
I can certainly jump on a quick call with you in the next half an hour if you would like to, as I’ve just come off the phone to another client so I’m still awake.
Either give me a call in the next 30 minutes or I can call you if you prefer.
Also, my phone is on if you have any questions or if you need reassurance later.
thank you for the reply
My father is getting 50-Mcg/hr Fentanyl and 5-mg/hr Midazolam. And top up doses of Fentanyl in between also.
His blood pressure is dropping slowly but all monitors were turned off in the room we are in hours ago. But they are monitoring him in another room.
Sent from my iPhone
that’s a standard dose of Fentanyl and standard dose of Midazolam for such a situation. Also, top up doses of Fentanyl(Bolus).
Given that you mentioned your Dad made noises yesterday and is not now, I think you can be fairly confident he’s not in pain.
If you have concerns about pain please talk to the doctors and the nurses. Fentanyl is a very strong pain killer!
I know, it’s a difficult situation, especially being in the middle of the night and after so much you have been going through over the last few months to help your Dad and also to help your Mom and brother to deal with this.
One thing that I learned over the years, having seen hundreds of Patients die in Intensive Care is- no matter how hard and difficult it is to lose a loved one- it is OK when we die. It’s part of life.
I don’t want to sound cliché, but from my perspective it’s nothing we need to fear. I know it’s easier said than done, but just by you being there will help your Dad!
And give yourself a pad on your back for being there for your Dad!
You are in a privileged situation to be with your Dad in his last hour!
Please let me know if you need anything, just give me a call!
- “PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE!”
Thank you Patrik
My strong dad took his last breath at 1.15am and his heart stopped at 1.36am He went peacefully Thank you for your assistance and reassurance during this time.
Veronica and Family
I’m very sorry to hear that your Dad has passed away.
It’s good to hear that you were there for him in his final hours and again, you should be very proud of yourself for being with him and supporting him and your family until the end!
For now, I wish you and your family all the strength, compassion and determination to deal with the loss of your father and should you wish to follow up on the circumstances that led to your Dad’s passing, I would be very happy to debrief with you on this.
We can also review medical notes if you feel like this is of benefit for you and your family, it can often help to clarify exact circumstances and it helps with closure.
I appreciate you being a client and I enjoyed working with you and supporting you with this.
Please do not hesitate to contact me if you need any help!
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?
You get to that all important feeling of making informed decisions, get PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below!
In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to make informed decisions, get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care!
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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