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 my client Veronica and the question last week was PART 2 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 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 3)
Veronica continues with her Dad’s situation below as follows
My dad is so precious to me and I want to know I am doing everything I can to help him recover if possible. And to know everything possible is being done to help him whatever the outcome I need that reassurance he was cared for and given every chance to try to recover. My dad is a strong man mentally and physically he was extremely active even a few days before being admitted to hospital and he deserves the best care possible.
If you get this email please send the list of what else I need to find out.
It’s good to know that you have spoken to the Cardiologist and got his views.
It’s also good to know that your Dad is on Propofol and not on Midazolam.
Even though I believe an Angiogram would be good for clarity what’s happened with your Dad’s heart, the Heparin he’s getting would be prohibitive for an Angiogram as he’s at high risk of bleeding with the Heparin.
If Troponin levels are within normal range it minimises the risk that your Dad sustained a heart attack indeed. It might well be a stress Cardiomyopathy. Hopefully that’s the case and the heart will go back to normal.
It’s a good sign that your Dad is responding to you, especially with the stroke from last week, I see this as a very good sign.
There are a number of things you should get updated on daily, just as we discussed yesterday. I can give you a whole list of updates you should be getting daily tomorrow.
It would also be good to know what ventilation settings he’s on.
When you go to the hospital, the following is important
- What sedation and how much sedation he’s on
- His ventilation settings and what’s their plan with ventilation, are they trying to wean him off the ventilator and get him out of the induced coma?
- Chest x-Ray results
- Blood results, especially infection markers such as White Cell count but also Haemoglobin, Platelet count and Neutrophils
- If he’s still on inotropes such as Noradrenaline
- What is his neurological response, I.e. is he responding, especially in light of the stroke from last week. In fact, find out what his Glasgow coma scale(GCS) is and I will talk you through what it means when we’re back on the phone
- Is his skin intact? Especially when being bed bound they need to manage his pressure area care
- Is he in a regular or irregular heart rhythm? Again with the ejection fraction low(35%) there is a bigger risk of the heart beating irregularly such as Atrial Fibrillation(AF)
- What is his blood clotting doing in light of the Heparin he’s getting? This is often stroke prevention therapy to keep the blood thin, but it shouldn’t be too thin
please find arterial blood gas parameters here
Normal levels are
- oxygen (PaO2): 75 to 100 mm Hg (10.5 to 13.5 kPa)
- carbon dioxide (PaCO2): 38 to 42 mm Hg (5.1 to 5.6 kPa)
- Arterial blood pH: 7.38 to 7.42
- Oxygen saturation (SaO2): 94% to 100%
The above are the most important levels when it comes to determining the effectiveness of mechanical ventilation
Other results they are getting from an arterial blood gas are
Those results are not as important but they still give some indication of what else might be going on.
I hope this helps, please let me know what you need next.
That’s the most important stuff you need to know. Please give me a call anytime.
Or let me know what time you want me to call you.
Again, I can talk to the doctors/nurses when you are there too.
Here are Dad’s levels and results
Oxygen from ventilator 45%
Carbon dioxide on expired co2 is 32-35
Arterial ph 7.42
Oxygen saturation 100%
Lactate down now was slightly high
The nurse looking after dad said they still can not print any reports as their IT is trying to fix their printers atm.
I did not go back in as they can not give me copies until its fixed she said she will try to email the scan reports to me.
Thank you for sending this through
Those numbers look all good.
I would still be interested to know his PO2 level. PO2 level is the oxygen level in the arterial blood and may actually vary from the oxygen saturation.
Especially with FIO2 from the ventilator still at 45%. The 45% oxygen level is still too high. For example, in order to wean your Dad off the ventilator, he needs to be on less than 35% of oxygen (FIO2) from the ventilator
The PO2 level actually determines if oxygen on the ventilator needs to be reduced or increased.
Also, with significant lung disease, PCO2(Carbon dioxide) levels can be increased as well and they look normal, which is good.
I would also be curious to know what other ventilator settings he’s on. Other parameters you may be asking for is PEEP and Pressure support. It would also be good to know if he’s doing some of the breathing himself or if the machine is doing most of the work.
Also, have a look at this article/video here so you can determine if they are doing all the right things to get your Dad off the ventilator.
If for whatever reason they can’t wean your father off the ventilator and the breathing tube they may consider a tracheostomy in consultation with you, your Mom and your father if he’s getting more awake.
Have a look here to find out more about how long his breathing tube/endotracheal tube should stay in and whether he should or shouldn’t have a tracheostomy if they can’t wean him off the ventilator
But overall his numbers, including Haemoglobin look pretty good.
No reason for “doom and gloom” at this stage.
A high lactate level can actually indicate an infection as well and if it’s normal that’s a rather good sign.
Happy to discuss over the phone whenever you want to.
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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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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