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 one of my clients and the question in last week’s episode was
You can check out last week’s question by clicking on the link here.
Paula has her father transferred in the Intensive Care due to a torn aorta. In the end, her father had undergone an emergency tracheostomy and open heart surgery, a growing concern is that her father is unable to come-off sedation due to behavioural changes during waking moments.
My father has a tracheostomy and the ICU doctors are planning LTAC! How can I keep him in ICU?
Patrik: Hi, is this Paula?
Paula: Yes, this is Paula.
Patrik: Paula, it’s Patrik here from Intensive Care Hotline. How are you?
Paula: I’m okay.
Patrik: I just got your message. I was on another call when you phoned, so I’ve got about 15 minutes now if you have time. Excuse me, I’ve just got to clear my throat.
So your dad is in ICU and now, they have done a tracheostomy already, have they?
Paula: Right, he’s sedated. He was on a ventilator, now they’ve trached him. They did a pacemaker. He’s not taking any IV medication anymore except the sedation. And they say that they can’t un-sedate him because he gets apprehensive as they start to wake him up.
Patrik: Sorry, can you repeat that? Why can’t they stop sedate him? Why is that?
Paula: They say that as he’s starting to wake up he gets apprehensive, and he starts to breathe really heavy-
Paula: -so they sedate him again right away.
- THE 5 THINGS YOU NEED TO KNOW IF YOUR LOVED ONE IS CONFUSED, AGITATED AND DELIRIOUS IN INTENSIVE CARE!
Patrik: Okay, how many days has your dad been, I see just over two weeks.
Paula: Just over two weeks, yes.
Patrik: Right. And they did the tracheostomy when? Yesterday?
Paula: Two days ago.
Patrik: So Saturday?
Paula: No, it was like four days ago.
Paula: It was right after Labor Day.
Patrik: Okay. And in your email you’re saying your dad had surgery for a torn, is it an aorta or an aroma. You say aroma … but it must be an aorta. Can you just fill me in?
Paula: It was the aorta.
Patrik: Okay, okay.
Paula: It was his aorta.
Patrik: And what, why couldn’t he get off the ventilator in the first place? Were there any complications?
Paula: Every time they would try to wake him up, or he would cough, he would bite on the ventilator tubing.
Paula: And he would cut off the airways.
Patrik: Right, okay. Was the surgery elective or emergency?
Paula: It was emergency.
Patrik: It was emergency. So they basically rushed your dad to hospital, and they operated on him fairly quickly?
Find more information about open heart surgery:
Paula: He was in the emergency room like 4:00 in the morning, by 9:00 he was on a surgery table.
Patrik: Okay, and what happened? Why did he go to the emergency room? Because he had water in his lungs?
Paula: Well the night before, he gone to bed, he said that his throat hurt. And he said his back hurt, and he was in bed, and he didn’t get out of bed. And then at 4:00 in the morning, because I live with him, I heard … his light was on, and I heard like a noise. I went in to see where he was, and he was like sitting on the edge of the bed with his feet on the floor and we was laying down. And I asked him what was wrong. I said, “Can you breathe?” He said, “Yeah.”
And then I tried to get him up, but he couldn’t like help himself up. And then he said he was hot, and my father is always cold. So I called 911. And then they took him to the emergency room, and then they saw with an X-ray that the aorta was ripped, torn.
Hello? Hello? Hello?
Patrik: Hi Paula, it’s Patrik again, can you hear me?
Paula: Yes, I can hear you, we got disconnected.
Patrik: Right, I could hear you perfectly fine but then … I could hear you, you were asking whether I could hear you, then I thought I’ll hang up and try again. Anyway, I can hear you perfectly fine.
Okay. So, he would have lost a lot of blood before, and probably during surgery as well.
Paula: Oh yes, definitely. They had given him 10 pints before the surgery.
Paula: Renal fail … no he has one kidney and it happens to be working, but the nephrologist is amazed at how well his kidney is working.
Patrik: Okay, because that is one of the major side effects of an aortic dissection … going into kidney failure afterwards. Well, that’s good that it didn’t happen. You are the medical power of attorney?
Paula: That’s correct.
Patrik: Did you have second thoughts about consenting to a tracheostomy?
Paula: For the trach, yes I did. They kept saying that he can’t breathe, and every time he would cough, he would get bright red, and he would choke. He would chew down on the breathing tube, and then his pressure would go crazy. Now, he’s not on any IV medication at all, and he’s taking an oral pill for his blood pressure, which they say seems to be helping him.
- THE 7 ANSWERS TO THE 7 MOST FREQUENTLY ASKED QUESTIONS IF YOUR LOVED ONE REQUIRES ONGOING MECHANICAL VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!
- FOLLOW THIS PROVEN SYSTEM TO AVOID THE 3 MOST DANGEROUS MISTAKES YOU ARE MAKING BUT YOU ARE UNAWARE OF, IF YOUR LOVED ONE REQUIRES LONG-TERM VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!
Patrik: Okay, what’s his-
Paula: Now, they want to push him out.
Patrik: What’s his blood pressure like? High or low?
Paula: He has high blood pressure. For him right now, his blood pressure is running like 132/90 with the medication. Right after the surgery, it was very low. It took them a long time to get it up.
Patrik: Right. Yeah, yeah. Especially with all the bleeding. Do you know what he’s getting at the moment to contain his blood pressure?
Paula: I wrote it down. It’s something … I wrote it down.
Patrik: I’ll mention a few. Metoprolol?
Paula: It starts with an A, I think.
Patrik: With an A?
Paula: Yeah. I had them spell it for me.
Patrik: It’s not adrenaline?
Paula: I wrote it down. What did I do with it? No, it’s something with a P-acholine or something like that.
Patrik: Not aminophylline.
Patrik: Okay. Well, that’s okay. Don’t worry too much about it. Don’t worry about it. What’s the bottom line probably is that with the tracheostomy.. the minute … based on the tracheostomy … they probably started talking about LTAC (Long-term acute care). Is that correct?
Paula: Oh yes. Oh yes. Even before they did that. The week … even the week … my father was four days out of surgery and they were already talking about a long-term healthcare and he hadn’t even woken up yet.
Patrik: Do you know much about LTAC? Have you done any research? Do you know much about it?
Paula: I don’t know much about it. I do know they say they’re going to send him there to help him get off the trach. It’s supposed to help him … they wean him … that’s what they say.
Related information and article:
- INTERVIEW WITH CHARLIE ATKINSON WHO WAS A PATIENT IN ICU& LTAC FOR MORE THAN 12 MONTHS AND SURVIVED AGAINST THE ODDS! LISTEN TO CHARLIE’S INSPIRATIONAL STORY!
Patrik: Right. Have they given you any time frames?
Paula: For him to get off the trach?
Patrik: That, and, or LTAC. Either getting off the trach and, or LTAC. Have they given you any time frame?
Paula: No. They haven’t given us any time frame.
Patrik: I’ll tell you what I can see, Paula, so far.
- “FOLLOW THIS ULTIMATE 6 STEP GUIDE FOR FAMILY MEETINGS WITH THE INTENSIVE CARE TEAM, THAT GETS YOU TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE FAST, IF YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!”
Patrik: Let me ask one more question. Do you know what sedation he’s getting? Do you know what they use to put him asleep?
Paula: Oh yeah. They’re giving him propofol.
Patrik: Propofol. Okay. He has been on propofol all the way along, or did they change that? Do you know?
Paula: They had tried to take him off and put him on something else that was not as strong, and then when he woke up he would get apprehensive, and at times … in between that … at times, they had given him morphine, too. They said that his heart rate would just go crazy.
Patrik: Do you feel that when they put your dad asleep, do you feel he’s comfortable, at least? Is that your impression?
Paula: Yes. He looks comfortable. Yes. That’s why they say they put him to sleep, because he looks like he’s uncomfortable. When he’s sleeping, he does look comfortable. But, he was awake a little bit … before they did … and they did a feeding tube, too. Before they did the feeding tube, when they would wake him, he kind of looked like he could hear us. We were talking to him and he would acknowledge us.
Patrik: Have they done a CAT scan of the brain?
Paula: No. For some reason, they haven’t done that yet. They said because he’s not awake. My brother and I both insist that they do that, because that really determines a lot of things.
Patrik: Absolutely. I tell you what I can see from my experience. Number one, one of the main reasons patients have a tracheostomy is to wake them up and not use sedation like propofol. This is always the situations that you’re describing at the moment, that patients don’t wake up properly. That always does happen.
I can tell you that with a leaking aorta and the emergency surgery, I would say … you know, I’ve seen a fair few of those type of surgeries over the years. It’s one of the main side effects … people don’t wake up, and that’s even worse with increasing age. It’s a situation that I have seen before. That’s number one.
That doesn’t eliminate the fact that patients who have a tracheostomy should be woken up as quickly as possible. That’s the whole purpose of a tracheostomy, right?
Paula: Right. That’s what I thought, too.
Patrik: Absolutely. So, the whole purpose of a tracheostomy is, generally speaking, making patients more comfortable if they can’t come off the ventilator straight away. May I ask, do you think your dad is more comfortable with the tracheostomy compared to the breathing tube in his mouth?
Patrik: So, then if patients don’t wake up after they’ve had a tracheostomy, and if they are agitated, the next step really is to do a CAT scan of the brain. The reason for that is simply, your dad could have, in theory, had a stroke, right?
Paula: I know.
Patrik: They need to rule that out. They need to rule that out.
Patrik: When was the last time when you felt your dad is acknowledging you, and your dad can see you, and your dad is basically aware of what’s going on? When was the last time you would say that was the case?
Paula: Well, we just had this big hurricane here, so we weren’t able to go to the hospital for the weekend, but I would feel Wednesday night. I could swear that when I was there, he was semi-awake and I was talking to him, and I could swear that he was kind of following my voice with his eyes. It could be in my imagination, but I swear he blew me a kiss.
Patrik: Okay. Good. Good.
Paula: It could have been my imagination.
“Thank you very much for being a part of the previous series of 1:1 consulting and advocacy sessions. We hope you will find these new upcoming episodes informative and empowering.
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!
- The 10 COMMANDMENTS for PEACE OF MIND, control, power and influence if your loved one is critically ill in Intensive Care
- What could be the cause if my critically ill loved one is removed from an induced coma but still hasn’t woken up?
- My 80 year old father is in Intensive Care with Myeloma! The Intensive Care team HAS ASKED ME TO SIGN A “DNR” AND I REFUSED! What are MY OPTIONS?
- The 3 most dangerous mistakes that you are making but you are unaware of, if your loved one is a critically ill Patient in Intensive Care
- The 5 questions you need to ask when the Intensive Care team is talking about “Futility of treatment”, “Withdrawal of life support” or about “Withdrawal of treatment”
- HOW TO STOP BEING HELD HOSTAGE BY THE INTENSIVE CARE TEAM if your loved one is critically ill in Intensive Care!
- 5 POWERFUL THINGS YOU NEED TO DO IF THE INTENSIVE CARE TEAM IS NEGATIVE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- My Mum has been diagnosed with STOMACH CANCER and is in ICU ventilated. CAN I TAKE HER HOME on a ventilator?
- The questions you need to ask the most senior doctor in Intensive Care, if your loved one is critically ill in Intensive Care
- How long does it take for my critically ill loved one to be taken off the ventilator and have their breathing tube/ endotracheal tube removed
- Why you must make up your own mind about your critically ill loved one’s situation in Intensive Care even if you’re not a doctor or a nurse!
- The ELEPHANT IN THE ROOM or HOW THE INTENSIVE CARE TEAM IS MAKING DECISIONS whilst your loved one is critically ill in Intensive Care!
- MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO?
- 5 ways you are UNCONSCIOUSLY SABOTAGING yourself whilst your loved one is CRITICALLY ILL in Intensive Care and HOW TO STOP doing it!
- How to make sure that “what you see is always what you get” whilst your loved one is critically ill in Intensive Care
- 5 Ways to have control, power and influence while your loved one is critically ill in Intensive Care
- Family overjoyed as top court rules doctors must seek consent before taking a patient off life support
- How to make sure that your values and beliefs are known whilst your loved one is critically ill in Intensive Care
- My loved one has HIV, lymphoma on his brain, seizures, septic and is ventilated! The Intensive Care team is trying to TAKE MY HOPE AWAY and they are all NEGATIVE! HELP!
- MY PARTNER IS IN INTENSIVE CARE AFTER A BLEED ON A BRAIN! WE ARE WORRIED THAT THE INTENSIVE CARE TEAM WANTS TO SWITCH OFF THE VENTILATOR! HELP!
- HOW TO DEAL WITH A DIFFICULT INTENSIVE CARE TEAM, WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- What the doctors and the nurses behaviour in Intensive Care is telling you about the culture in a unit
- How to take control if your loved one has a severe brain injury and is critically ill in Intensive Care
- How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 1)
- How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 2)
- The four DEADLY SINS that Families of critically ill Patients in Intensive Care CONSTANTLY MAKE, but they are UNAWARE OF!
- My HUSBAND had a HORRIBLE work accident and went into CARDIAC ARREST! Will he be PERMANENTLY DISABLED
- Why decision making in Intensive Care GOES WAY BEYOND your critically ill loved one’s DIAGNOSIS AND PROGNOSIS!
- The 4 ways you can overcome INSURMOUNTABLE OBSTACLES whilst your loved one is critically ill in Intensive Care!
- How to get PEACE OF MIND, more control, more power and influence if your critically ill loved one is DYING in Intensive Care!
- The 5 QUESTIONS you need to ask, if the Intensive Care team wants you to DONATE your loved one’s ORGANS in an END OF LIFE SITUATION!
- MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART 1)
- How MEDICAL RESEARCH DOMINATES your critically ill loved one’s diagnosis and prognosis, as well as the CARE and TREATMENT your loved one IS RECEIVING or NOT RECEIVING
- WHAT WOULD YOU DO if you knew that you COULD NOT FAIL, whilst your loved one is critically ill in Intensive Care
- How the Intensive Care team is SKILFULLY PLAYING WITH YOUR EMOTIONS, if your loved one is critically ill in Intensive Care!
- My father is in Intensive Care ventilated with LIVER FAILURE and KIDNEY FAILURE, I DON’T THINK HE WILL SURVIVE! HELP
- HOW TO GIVE YOURSELF PERMISSION TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. When can the Tracheostomy be removed?