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 was
You can check out last week’s question by clicking on the link here
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Camille, as part of my 1:1 consulting and advocacy service! Camille’s brother is brain dead in the ICU and the ICU team wants to issue a Do Not Resuscitate (DNR) order. Camille is asking why is it important to know what DNR status means.
My Brother is Brain Dead in the ICU and the ICU Team Wants to Issue a “Do Not Resuscitate” (DNR) Order. Why is it Important to Know What DNR Status Means?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Camille here.”
Patrik: I don’t know a doctor who would allow you to transfer him, but I’ll tell you what I think. You need to get an injunction to stop them from doing what they’re doing. Right. That’s number one. Once you’ve got the injunction and you have time, cause all you need for now is you need time. Okay. Once you’ve gotten an injunction, you will need to look at those options that I mentioned to you before. Potentially New Mexico, where somebody, because again, in some states, a person whose brain dead is legally dead. Right. In other states and especially in New Mexico, if people are brain dead, they are not legally dead.
Camille: Okay. Do you know of any other states?
Patrik: No. No. I don’t. However, however, if you will. I think again, probably ask Google saying something, like “legally dead brain dead.” I don’t, I don’t know. I’ll tell you what you could do as well. You could, I’ll tell you what I’ll do. I’ll tell you what I’ll do when we come off this call. I emailed you, what’s the name of the policies? No, and I will email you a link to Professor Pope’s blog. He has a blog and he’s blogging all about that and he must have a search box on there and he would have, I don’t know, type in “brain dead New Mexico” or something like that. Something will come up. Something will come up.
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Camille: Yeah. Because I actually live in the state of North Dakota, so we just like abandoned our home. It’s about one hour and 45 minutes from Bismarck. So that’s, we’ve actually abandoned our house. Hope that there are no hoarders coming in and living there. And so that’s what’s going on, we’re just living at a motel now.
Patrik: Right, right, right. Look, I think I could be wrong there, but with gain going back to Nadine M., this 13-year-old girl, given that they basically transferred her from Oklahoma to New Mexico. I would imagine there are not many states where death doesn’t mean legal dead. Right. But you know, I mean they’ve traveled, they basically are transferred to her through half of the country, all across the country.
Camille: Did the insurance coverage it? Do you know?
Patrik: I don’t know. I really don’t know. Again, I’m pretty sure you will find information online. Right. But I wouldn’t know. I don’t, I tell you what I think what I tell you what I think happened. I think the family sued the hospital in Oklahoma for malpractice, and I’m pretty sure they got a payout or something like that. I’m pretty sure. But look, I don’t know. That would probably in a situation like that, there would probably also be some religious groups who may potentially want to help you.
Camille: Yes, yes. Which is why I’m so stuck with everything. You know, I’m taking care of my mother and my daughter and my niece. I mean, and I’m just and also just doing all my work and just be able to. I still have to work, but I do some online, which it’s okay. And it’s just, I get maybe like two hours sleep a day.
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Patrik: Yeah, that’s not sustainable.
Camille: We’ll walk into a bunch of wolves. That’s another story. Yeah, if you could, I think that would be wonderful. Anything that you can do to help me, cause the time that I sat there today took me like five and a half hours just to try to look for an attorney and I got on the phone, they said: “no, no, no.” Everybody said no.
Patrik: Right. Okay. But that was before. That was before they were telling you Wednesday at five o’clock
Camille: Yes.
Patrik: Right. So now you might be in a different, you look again, I’m not an attorney. I know you probably, I think you’ve got to stay in contact with Professor Pope because I know he’s been working with a client in Arkansas and not, not that we were involved there, but he’s been definitely dealing with similar clients. I think from my perspective and in different states, but it probably is a matter of, has he got the time? I don’t know. I can help you with the clinical side. I can’t help you with the legal side. Right?
Camille: Yeah.
Patrik: So what I’ll do, Camille, is I’ll email you the name of the policies that you need to ask them. And I will email you a link to Professor Pope’s blog and have a look there or whether, have a look there, whether, there’s some information which states in the U.S. that don’t recognize brain dead as legal dead.
Camille: Yes. Yes. Okay. We’ll do that. Sounds great. I really, really appreciate it.
Patrik: You’re very welcome.
Camille: All right, we’ll be in communication then.
Patrik: Yeah, okay. All the best. Bye. Bye.
Camille: Okay.
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Camille: Hello, this is Camille.
Patrik: Hi Camille. It’s Patrik here from Intensive Care Hotline. How are you?
Camille: I’m fine, thank you.
Patrik: How is your brother?
Camille: Well, right now his blood pressure is 104 over 63 and his medium is 76.
Patrik: So you are there at the moment?
Camille: Yes, I am here. Yeah.
Patrik: Right.
Camille: They called us and said his blood pressure was low. The thing is when he’s on his back when he’s lying flat on his back, but even if he’s elevated, his blood pressure drops to… let me see here, 71 over 51. Medium is 57.
Patrik: Right. And what is he on? Do you know what he’s on in terms of medication?
Camille: Let me check here.
Patrik: Let me ask you a different question. Are they increasing the life support for him? They must do because otherwise if his blood pressure drops, right, and it’s up now?
Camille: Yes. Covidiens, it says here Covidiens equip safety through. It says Covidiens. That’s Kangaroo or something like that?
Patrik: That’s the pump. I’ll tell you what you should be asking for.
Camille: And he’s also getting food.
Patrik: Okay. I’ll tell you what you should be asking for. If his blood pressure drops, and they’re saying that he’s dying because his blood pressure drops, you should be asking for epinephrine or norepinephrine. I will email that to you when we come off this call. Epinephrine and norepinephrine, it’s basically a drug that increases blood pressure. And it’s basically life-sustaining. Right.
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Camille: Right. Right.
Patrik: So, just give me one sec please. The question is… Just give me one sec. Just give me one sec. Can you still hear me?
Camille: Yes, I can still hear you.
Patrik: Okay, great. I am just… Just give me one sec. I am just quickly… Have you got access to your email?
Camille: Yes, I do.
Patrik: Okay, so I’ll just email you two drug names that you should be asking for and it’s coming through now. So whenever somebody has low blood in intensive care that is potentially incompatible with life because if your brother’s blood pressure drops significantly he could die, which is pretty much what they told you. However, those drugs could buy your brother’s time.
Camille: Good.
Patrik: And just like ventilation, ventilation is life support and those drugs are considered life support as well. For example, if somebody has a cardiac arrest, those drugs, epinephrine, and norepinephrine are the drugs of choice. Right. During a cardiac arrest for example. Right. And they are also the drug of choice to keep somebody alive if their blood pressure drops.
Camille: Yes.
Patrik: Right. The question that I have is what potentially, and the DNR in this hospital means, does that mean he’s just not for cardiac compressions or has they ruled out giving him the epinephrine and norepinephrine as well? Are you following?
Camille: Yes, I am following. I’m just writing them down.
Patrik: Because that is really the question. In some situations, a DNR means no cardiac compressions in case of a cardiac arrest. In some situations, a DNR means not for cardiac compressions but also not for vasopressors. The epinephrine and the norepinephrine are classified as a vasopressor.
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Camille: As vaso…?
Patrik: I’ll email it to you. Vasopressor. I’ll email it to you.
Camille: Okay, vasopressor.
Patrik: So I’ve emailed you the drug names already.
Camille: Yeah, I got the drugs already. Thank you.
Patrik: Right. And I will just quickly email you further to that that they are called vasopressors. Just give me one sec, I’ll just type that in the email. So that’s just coming through. So do you think that when they called you, that call was accurate? Or do you think that it was just a scare to potentially provide your further to their plans? You know what I’m saying?
Camille: Yes, yes, exactly. I think it was.
Patrik: Do you think it was their plans?
Camille: Yes. Yes.
Patrik: Right. Right. Okay. Any progress with the attorney?
Camille: No, not even one. Not one. And I talked to your friend and he said to look up one and was exactly… I asked him if he could recommend and he didn’t know anybody in this area.
Patrik: Right. And he wouldn’t take it on? He wouldn’t take it on himself, would he?
Camille: I did talk to somebody, one of the attorneys. I talked to them down further South of Utah, about three hours from here. And they told me that all these attorneys are afraid of this hospital.
Patrik: Wow. All right. I see. So it’s the hospital. It’s not the case as such, it’s the hospital.
Camille: Yes.
Patrik: I tell you what I would suggest if I was you. Given that he’s in a life-threatening situation still and potentially getting worse fairly quickly, I’ll tell you what I would recommend. And given that you can’t get hold of a lawyer, I would really ring up the police and ask them what they suggest.
Patrik: And I don’t know whether they can help you or they can’t, but they may. You got to explain the situation to them. You got to explain to them that you need an injunction. You got to explain to them that you can’t get a lawyer this weekend or on the long weekend. And you’ve got to see what they suggest.
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Camille: Yes.
Patrik: Right. That’s what I would do because it sounds to me like… And what you got to find out whether the DNR means no vasopressors or does it mean just no CPR. Do you know what I’m saying?
Camille: Yes. Yes, I do.
Patrik: Right. Because that’s really important because if his blood pressure drops to a degree, that is not sustainable with life, that is not compatible with life and they’re not giving the norepinephrine or the epinephrine, your brother will die.
Camille: Yeah.
Patrik: Right. And that that is why this question of is he on norepinephrine or epinephrine or are they considering using it in case your brother deteriorates? That is going to be a really important question.
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Camille: Yeah.
Patrik: Right. Another way to manage low blood pressure is to give fluids. That’s another way to manage low blood pressure. In a life-threatening situation where the blood pressure is not compatible with life, as I said, the epinephrine and norepinephrine are the drugs of choice.
Patrik: Another way to manage a really low blood pressure that’s not compatible with life is to give fluids. And that could be from giving some normal saline but also potentially giving some blood products such as albumin or even a blood transfusion. They are all important question because again, it keeps coming back to the DNR. What does the DNR mean? Does it mean just no cardiac compressions or does the DNR rule out any of the things that I mentioned like vasopressors as well as fluid resuscitation?
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Camille: Yes.
Patrik: Right. You need to stop me if I’m too medical if I’m getting too medical. Do you need to reel me in?
Camille: No, no, no. I understand, but yeah, his hands are swollen.
Patrik: Right. His hands are swollen and he might be slightly fluid overloaded. But in a situation where his blood pressure is unsustainably low, they got weigh up do we need to give him fluids? Does that need to be part of the resuscitation?
Camille: Oh, I see. Okay. Okay.
Patrik: Right. And he might be swollen just by being immobile for the last six weeks. He doesn’t necessarily have to be fluid overloaded to be swollen. It could just be from him being immobile.
Camille: Exactly. Exactly. That’s what I feel too. I feel the same thing. So when we come here, we always exercise him.
Patrik: Right, right.
Camille: We move is legs and his arms and everything.
Patrik: The other thing-
Camille: I don’t know if that’s good.
Patrik: No, no, I think that’s good. No, no, no, no. I think that’s good. The other thing that I would do if I was you to keep the pressure on because you haven’t been able to talk to a lawyer yet. I would…
Camille: I can’t even get one.
Patrik: That’s right, that’s right.
Camille: Right now, all I can do is rely on faith.
Patrik: Well. . .
Camille: Honestly. Unless I can go there and do it myself, as procure. But I just need to know how to do it.
Patrik: Yeah, yeah, yeah, yeah.
Camille: Maybe you can give me an example.
Patrik: Right. Have you spoken to Professor Pope over the phone?
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Camille: No.
Patrik: Right. Just via email? Right, right. I mean, I don’t think he’s scared of taking any cases on, I think for him it’s a matter of time. Right.
Camille: He says that he can’t do it in another state.
Patrik: Oh, okay. I know he was having a client the other day in another state. It was in the media in fact. He had a client in Arkansas. He was in the media not too long ago.
Camille: Oh, okay.
Patrik: Right, right.
Camille: That’s the strangest question. Why doesn’t anybody want to take media?
Patrik: Yeah, yeah, yeah, yeah. Look, I don’t know why.
Camille: Can you find out? Is there a way for you to ask him and find out?
Patrik: I will find out. I’ll email him. I’ll email him and see what he says. For example, have you asked him specifically about what to do if you can’t get a lawyer? Have you specifically asked him that question?
Camille: Yes. And all he did was said, here are some links. Look up some other lawyers. I don’t even know what kind of lawyers to look up. So at for helping me again, it’s just, I don’t know. I call one lawyer. “Oh, we don’t handle that.”
Patrik: Look. I will email him. I’ll copy you in.
Camille: Thank you.
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Patrik: But in the meantime, I would really go to the police. That’s what I would do because they might have some ideas for you.
Camille: Okay.
Patrik: And you probably should also mention to the hospital that you are in the process of getting an injunction to keep them on their toes.
Camille: Okay.
The 1:1 consulting session will continue in next week’s episode.
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- 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!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
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