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
My Dad is with Tracheostomy & is Always Sleepy. Do Sedatives Make His Condition Worse? Help!
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 Nestor, as part of my 1:1 consulting and advocacy. Nestor’s wife is intubated for 4 days in ICU and he is asking if the doctors want to do tracheostomy and PEG already so they can send his wife out to LTAC.
My Wife is Intubated for 4 days in ICU & They Want to Do Tracheostomy & PEG (Percutaneous Endoscopic Gastrostomy) Already So They Can Send Her Out to LTAC! Help!
Nestor: Hello, this is Nestor.
Patrik: Hi, Nestor, it’s Patrik here from Intensive Care Hotline. So, I got your voicemail.
Nestor: Okay. I’m just stepping out of my wife’s room so I can talk to you.
Patrik: Right. Sure.
Nestor: Okay, so doctor came in to speak to me today, and she was a cardiologist, which she was basically telling me the same thing that they’ve been saying, and they want to put in a trach and, what is it, a PEG?
Patrik: A PEG (Percutaneous Endoscopic Gastrostomy)? A PEG?
Nestor: Yeah. Right. So, they can send her to LTAC (long-term acute care).
Patrik: Yeah.
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Nestor: I told her that… I said, “First, four days was too short of a time to say, suggesting that I’m going to let you guys do an aggressive approach like that.” I said, “At this stage, it’s still too soon. You’re saying there’s no movement, however, you keep her sedated.” They just sedated her again, because they said that her body was fighting the respirator.
Patrik: Right. Mm-hmm.
Nestor: Fighting her ventilator, so they said they had to sedate her so it would allow the ventilator to breathe for her. So, what I wanted to ask you, I wanted to, because I told her that I didn’t want to do the trach, and the, what do you call it, a PEG?
Patrik: The PEG tube, yeah.
Nestor: Right. I said, “Can’t you just insert a tube through the nose for food?” She’s like, “Well, you know, infections and everything else can happen.” I asked her, I said, “Can you write these down? Can you write down your plan?” I said, “So I can take it and look over it, and I can talk with my advocate, and we can all sit down together and have a meeting so he can help me to understand what you’re saying.” She said, “Well, I’m just telling you…” I’m like, “Yeah, but you can you put it in writing?” And so, basically, no, that wasn’t something she was interested in, and so, from that point, I decided that I think the best way for me to let you read over the records was to give you her login and password so you can look and see.
Patrik: I think that is the best idea. Nestor, just a couple of things. Two things. Is there any way you could text or email me a picture of the ventilator?
Nestor: Oh, yeah, I could take one.
Patrik: That’s number one. Number two let’s just say a trach is the best course of action. We don’t know yet, but let’s just say a tracheostomy is the best course of action. If I was you then, then I would give consent to a trach, but I would not give consent to a PEG. You don’t need to give consent to both.
Nestor: Okay.
Patrik: Here is why I wouldn’t give consent to a PEG tube. If your wife doesn’t have a PEG tube, they can’t send her to LTAC. Okay, so why is that? LTAC will not take a patient with a tube in the nose. Most LTACs will all do that. They want a PEG, because LTACs, the skill level in those facilities, of the staff is pretty average, I would say, pretty poor. If she doesn’t have a PEG tube, they don’t feel they can look after her. So, by you not consenting to a PEG tube, you’re automatically putting a stop for her going to LTAC without compromising her care.
Nestor: Okay.
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Patrik: Right? So, no one can force you to give consent to both. No one.
Nestor: Right.
Patrik: But let’s look at medical records first, and let’s see. Send me a picture of the ventilator. She would be connected to a monitor at the moment.
Nestor: I know she’s… I don’t know.
Patrik: Right.
Nestor: It’s something in there. It may be a monitor. She is, she is, she is. They are checking the blood pressure there.
Patrik: Right. If you could send me a picture of the monitor as well, that would be great.
Nestor: Okay.
Patrik: Then, we can take the next steps. Now, when you’re saying you talked to the doctor, who is the doctor? Is she an intensive care specialist, what’s her credentials? Is she a pulmonologist?
Nestor: She’s a cardiologist.
Patrik: Cardiologist. Right. Okay. Is there an intensive care specialist as well that you’re talking to?
Nestor: I talked to the palliative doctor. I’ve talked to the cardiologist, and the attending doctor over CCU (Cardiac Care Unit). I did talk to one doctor that was an attending doctor for the CCU, but I haven’t talked to the newest one.
Patrik: Right. Who do you think is making the decisions? Is it the cardiologist?
Nestor: It seems like the cardiologist, because that’s the one, when they come, they were telling me, “Well, we need to,” blah, blah, blah. That’s the cardiologist.
Patrik: Right. Okay. Interesting.
Nestor: But her heart is beating by itself.
Patrik: Yeah. Yes, but I guess, given that she came in with a cardiac arrest, she would have some inputs, but most of the time, it’s the ICU that’s making decisions, most of the time.
Nestor: Mm-hmm.
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Patrik: That’s why I’m a bit surprised that she’s making decisions, but the hierarchies vary a little bit from hospital to hospital, who’s calling the shots. Just something for you to be mindful.
Nestor: I’m sorry. Go ahead.
Patrik: Just something for you to be mindful of. She might say she’s calling the shots, and tomorrow, you’ll be talking to the ICU specialist. I wouldn’t be surprised there. Just something for you to watch.
Nestor: Because I think what’s happening, I think they’re just passing the note on, “When you go talk to her, say this.” Somebody is saying, “This is what we’re going to say to her.” So, she came in to introduce herself, because she’s working this wing, and so, she said, “I’m the cardiologist that you’ll be seeing this week, and we’re going to watch over her.”
Patrik: Yeah.
Nestor: Wouldn’t we try to wean her off of the ventilator, see if she actually needed a trach? And she says, “Well, we’re watching. We turned it down,” because the ventilator was at 100%, and it’s down to 50% and she’s breathing 30% oxygen. That’s why they sedated her. And so, she said that because they’ve not gotten movement from her, and she is not reacting to any stimulation or pain or anything, then that’s why they’re considering a trach. But I also pointed out to her that yesterday, when she was awake, when she was not sedated, when she came, and her eyes followed me, and then I asked the nurse if she would go to the other side and see what happens, and she slowly turned her eyes. She slowly moved her eyes to her, and then I asked her if her pupils’ still reacting to light. She said, “I’ll show you,” and her pupils were reacting to light.
Patrik: Right.
Nestor: I felt like she was coming slowly. The brain was getting to where it may be healing or coming back together, but then they sedated her again with propofol.
Patrik: Well, most likely, Nestor, most likely. Send me a picture of the ventilator, because yes, you’ve told me what she’s breathing over, but there are numerous numbers that need to be looked at when it comes to reading of the ventilator. It would be critical if you could send me a picture of the ventilator.
Nestor: I’ll get that to you right away.
Patrik: Yeah.
Nestor: And do you want me to send the login to your email, because I think you informed me via message, and not through the support email.
Patrik: Both.
Nestor: Okay.
Patrik: Yeah, sure, when you’re ready.
Nestor: Okay.
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Patrik: Yeah. Wonderful.
Nestor: All right.
Patrik: Thank you.
Nestor: Okay, appreciate your time.
Patrik: It’s a pleasure. Thank you so much. Bye.
Nestor: Bye.
The 1:1 consulting session will continue in next week’s episode.
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Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
Make sure you also check out our “blog” section for more tips and strategies or send me an email to [email protected] with your questions!
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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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