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 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 Part 5 of
You can check out the answer to last week’s question by clicking on the link here.
Today, Heather asks
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? (PART6)
A few more issues have come up since we last spoke and they have now found that
- my partner has liver cirrhosis. This is the first I’ve heard of it when I visited my partner yesterday. They are giving him albumin and they have taken him off of the Lasix(Frusemide). They have done this before. Why does the swelling keep happening? They did a CT of his abdomen and he had fluid polling up there and he is leaking where his chest tube was.
- When he was first admitted to the ICU at the first hospital they wanted consent for a PICC line and that kidney doctor wouldn’t ok it so they went with the main line. The kidney issues were under control so the kidney doctor signed off the case. I was just wondering if the PICC line put some strain on the kidneys maybe? He is off of the Propofol and still on Fentanyl. He had hallucinations causing agitation that was due to pain I think. They gave him Delaudid(Hydromorphine) and now he is sleeping.
He’s still having the muscle spasms I think are because of the Quetiapine. I don’t know for sure though. They are also giving him Depakene. Is this stuff something that everyone who gets intubated gets or just him?
If it is for agitation or hallucinations it isn’t working.
I have read about several adverse reactions. Do you think if I asked them to stop giving them to him that it would make things worse?
I know these meds are for treatments of bipolar and schizophrenia and I don’t have a bias against that. I have had experience with mental illness and I know that it’s very much trial and error as to which meds are working and at what doses.
I don’t think with all of the other stuff going on we can accurately treat any of that, but I also don’t know if his mental state because of the other stuff could be worse without it.
I feel like my partner with no mood stabilizers and anti psychotic meds would be able to cope with things. I don’t know if you understand what I’m saying. Do you think it would hurt things if I asked them to stop those meds right now?
I also read something about those and the Nafcillin contributed to liver malfunction I have to do more research there. The nurse did say he had ICU delirium and Quetiapine is being used to treat psychosis.
I just want to know what you think because it could be I’m just picking on the Quetiapine. I did read something about it and liver. He just woke up and he is clearly hallucinating and mouthing help and sticking his tongue out. He starts breathing the machine and is now breathing more by himself.
It would be good if we can speak on Skype again so that you can explain to me what’s going on!
let’s look at the easy things first.
- No, there is no issue with PICC lines causing kidney disease whatsoever.
Given that your partner has liver cirrhosis, it would be good if you also told me whether the cirrhosis has been alcohol/ drug induced or whether it has been induced by acquiring Hepatitis inadvertently.
In any case, you’ve got to look at the bigger picture here.
His liver failed with cirrhosis and the challenge here is that numerous medications he is getting may not metabolise- or in other words don’t work- because of the liver not being able to process the drugs.
I therefore won’t be getting too caught up in what medications he’s getting or not getting and whether they are working or not working because of the inability of the liver to metabolise most of the drugs.
The main questions and issues you and your partner are dealing with are
And yes, swelling is a side effect of the liver failure/ hepatitis and therefore he needs Albumin to reduce the swelling. A failed liver stops Albumin production and with low Albumin people get swollen or oedematous.
All the medications your partner are getting is to keep him calm and pain free.
It’s particularly challenging because your partner is blind and he would be more agitated than other critically ill Patients in a similar situation!
Quetiapine normally works really well from my experience to calm Patients down when they are on a ventilator and delirious!
But all the medications he is getting, whether the Quetiapine, the Hydromorphine and the Fentanyl are there to calm him down and they probably work to a degree despite the liver failure.
The problem is that your partner has been in Intensive Care for too long now as he has reached the two month mark.
ICU psychosis or ICU delirium is a real issue and as I mentioned before, your partner not being able to see doesn’t help his case.
What needs to happen here is to wean the medications he is on off slowly over many days and he also needs to continue with Physiotherapy.
Physiotherapy and stimulation are so important that your partner can get back to normality! Drugs and medications can only ever be a short term aide, but never a long-term strategy!
Normally I would say that especially after two months in ICU, your partner should be moved into a room where he can have natural daylight, as most Intensive Care Units don’t get much natural daylight!
However with your partner’s inability to see, it may well not be so important, but it’s something you may want to keep in mind!
Furthermore, the nurses should be looking at getting your partner to have regular showers. This often works wonders too and can just be as good- if not better- as medicine, to get your partner out of the delirium and less agitated.
Unfortunately, all too often critically ill Patients in Intensive Care, especially long-term Patients in Intensive Care end up being delirious and agitated and it’s a big issue.
They may physically improve, however they are still in “la-la-land” so to speak and getting them out of that state is critical.
As I said before, drugs can only be an aid and not the cure. Stimulation, Physiotherapy, patience as well as good nursing care are often the answer.
You should also check out this article here for more information about delirium in Intensive Care
- THE 5 THINGS YOU NEED TO KNOW IF YOUR LOVED ONE IS CONFUSED, AGITATED AND DELIRIOUS IN INTENSIVE CARE!
You also mentioned Depakene and it’s unclear to me why he’s getting it. It’s normally given to prevent seizures, however you never mentioned anything about seizures. Maybe you can clarify if your partner had any seizures in the past or if he’s at risk of having seizures.
We also have a great resource(Ebook, Videos and audio recordings) available that’ll help you to steer the ship while your partner remains a long-term Patient in Intensive Care and is at risk for “treatment limitations” and “withdrawal of treatment”
FOLLOW THIS PROVEN 6 STEP PROCESS, ON HOW TO BE POWERFUL, IN CONTROL, INFLUENTIAL AND HAVE PEACE OF MIND, IF YOUR LOVED ONE IS A LONG-TERM PATIENT IN INTENSIVE CARE OR IS FACING TREATMENT LIMITATIONS IN INTENSIVE CARE!
I know Heather it’s easier said than done, but you need to be patient. Being critically ill in Intensive Care often means two steps forward and one step back. I know this situation is tiring, exhausting and extremely stressful for you, but you need to stay strong for your and your partner’s sake!
Your partner still has a long way to go and he needs to get out of the delirium first so that he can comply with the instructions, as well as the Physiotherapy in order to be weaned off the ventilator and the tracheostomy!
We’ll go on Skype again and talk about things in more detail!
How can you become the best advocate for your critically ill loved one and how can you 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 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 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 PEACE OF MIND, control, power and influence in your situation
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- 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!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!