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 last week was
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 Emma, which are excerpts from 1:1 phone and email counselling and consulting sessions with me and the question this week is
My sister is in ICU on a balloon pump and ventilated after cardiac surgery! The ICU doctors want to stop treatment against our wishes and let her die, what should we do? (PART 11)
In this series of 1:1 phone and email consulting and advocacy sessions with my client Emma you’ll get real in-depth knowledge about cardiac failure in Intensive Care, how it works, the treatment and therapy options, how to wean somebody off the ventilator and most importantly, you’ll discover how to not take “no” for an answer.
You’ll witness how I can lead Emma in going from the Intensive Care team trying to coerce her and her family to agree to a “withdrawal of treatment” as being “in the best interest” for her sister to challenge that and the Intensive Care team having to do everything within their power to safe her sister’s life and turning the dynamics upside down in Emma’s favour.
That’s what happens when you have the right advice from a professional who knows Intensive Care inside out and who knows how to manage the dynamics and who can take the fear away of being intimidated by the Intensive Care team!
Enjoy this consulting and advocacy session!
as of now we have not heard anything from the doctors regarding my sister’s surgery as instructed per you I spoke to the nurse’s and doctor concerning my sister’s WBC in which they say is ranging from 11 to 14 I was told that they will be changing out her dialysis line on today. The nurse say’s that they have decreased her dobutamine to 4 and the Norepinephrine is at 6, the nurse also says that her art-line blood pressure is 92/34 MAP of a soft 57-60 and that her cuff pressure is 96/52 with a MAP 69 and that she is on O2 at 6 litres nasal cannula throughout the night.
The nurse says that the cuff pressure is more accurate because of some wave form. The nurse’s keep telling us that the doctors are meeting to discuss concerning my sister’s needed live saving surgery. One of the doctors told me on Monday night that they will let us know by Tuesday information regarding my sister’s surgery it is now Thursday and thus far we have heard nothing from the doctor in regards to performing my sister’s surgery.
It seems they just have us in limbo. Please help me understand. Also please can we communicate via email I have returned to work, my brother in law is at the hospital with my sister at this time I am checking on her via phone with both her husband and the nurses and going to her bedside when I leave work. I am so exhausted and have let a lot of stuff in my personal life fall to the wayside.
Your sister’s vital signs are pretty good and considering that they are able to wean off the Dobutamine it means her heart is getting stronger. Not surprised the Norepinephrine is not off yet, as long as they will aggressively removing fluids from the Dialysis, she will most likely need the Norepinephrine.
Have they done an Ultrasound or Echo for the heart?
WBC(white blood cell count) is OK ish but I’m glad to hear they are changing her dialysis line, they should be doing the same for CVC and arterial line to minimize the risk for infection.
Reading the blood pressure via the “normal” blood pressure cuff makes sense and is usually more accurate than reading it from the arterial line. Her blood pressure is OK ish, not overly high with all the Dobutamine and Norepinephrine but it’s OK.
As it relates to the surgery, they are probably waiting to see if your sister can stay off the ventilator and if they can wean her off the Norepinephrine and the Dobutamine, she also needs to get stronger if she was to have surgery.
I fully understand how exhausted you must be and you need to keep looking after yourself, as you are very important in all of this.
I can see why they are not committing to surgery yet, even though your sister has come a long way in the last few days.
Moving forward, I would suggest the following
- They need to do an ultrasound/Echo of the heart
- Now is the time to talk to the surgeon and ICU doctors to work out what their plans are, now may also be the time to ask for a meeting from your end
- You need to pace yourself and keep looking after yourself, take a couple of days off and do something nice for you if you can
Contact me anytime, if you call me, you’ll probably get a much quicker response
Just a quick summary here from our phone call.
- try and engage the doctors and get answers re surgery
- keep asking for physical therapy and getting her stronger, she needs to get moving including getting out of bed
- if they can wean the Dobutamine whilst increasing or at least maintain her ejection fraction that would be great. In order to do that they need to assess with another Echo/ultrasound
- ask for fluid restriction. If your sister is on a fluid restriction and they keep removing fluids via CRRT she will have a hard time coming off the Norepinephrine
- nutrition, get them to give her food and drinks if she can tolerate it. The more “normality” the better
- if your sister has pressure sores the sooner she can get off the norepinephrine the better
- keep looking after yourself
- give yourself a pad on your back for working through probably one of the most difficult challenges in your entire lifetime and helping your family
- keep staying positive!
I just spoke with my sister’s nurse and she said that my sister’s vital signs are not good blood pressure 85/38 MAP 58 and that no fluid is being pulled during dialysis and she is not on a fluid restriction. She is now on Norepinephrine 6, Dobutamine 4 and Vasopressin 0.04. Her WBC count is 16 and Haemoglobin is 7.9. She said the surgeon’s will meet with the family on next week and will not be doing her surgery. The nurse is saying that we should consider termination of treatment on my sister, because my sister is suffering. I explained to her that my sister told our family that she would fight until her last breath and that she wants to continue to fight. The nurse said that the doctors are not addressing her increased WBC count now because she has no fever. She also said that physical therapy only did wound care on my sister, she has wounds to her sacrum, hip and lower legs. Please advise
That’s not so good news, at the same time it’s a setback, two steps forward one step back.
My first question to you is, do you think your sister is suffering?
Even if you think she is suffering, as long as she’s talking the best way forward is to ask her opinion and ask her what she wants. We all know that being so sick in ICU is not very nice but if it’s a means to an end and she wants to fight…
Also, they need to put things in perspective and acknowledge that she has gone a long way in the last 10-14 days.
It sounds to me like the doctors are trying to avoid you looking in the eye and I do believe that you need to ask for a meeting.
It is once again, highly inappropriate talking about “withdrawal of treatment” because your sister is suffering supposedly. It’s not for anyone to judge but your sister and her immediate family what is acceptable for future quality of life.
- THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO“LIMIT TREATMENT”>, WANTS TO “WITHDRAW TREATMENT”, “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!
It might be their default response especially if she’s not improving in a time frame that’s convenient for them, because they need the beds, staff and other resources…
It’s also very hypocritical to let the nurse deliver you the news about potentially “not doing the surgery”, you need to get it from the horse’s mouth and not second hand, that’s why talking to the doctors rather sooner than later will be important!
- She continues to be “dry” and they have been aggressively removing fluids in recent days which is lowering the blood pressure
- A low Haemoglobin doesn’t help at all and usually is increasing the demand for Vasopressin and Norepinephrine. Usually the threshold to transfuse a unit of blood is around ~7.0 and lower, but it would help with decreasing the Norepinephrine and the Vasopressin if they are not too aggressively removing fluids. As you can see, the body is a delicate system and especially in the critically ill you have to weigh up every decision in how it impacts all the other organs. A unit of blood would be good nevertheless as long as it doesn’t put too much strains on the heart
- The heart is weakening and therefore they had to reintroduce the Vasopressin and the Norepinephrine
- They need to do another Echo/Ultrasound of the heart to find out what’s happening with the heart
I’m still adamant that Physical therapy needs to be commenced ASAP and they need to work on building up her strength.
They will need to find out why her WBC has increased, even in the absence of a fever.
Furthermore, as far as her pressure sores are concerned, I hate to say it but it sounds like they have not been doing adequate pressure area care and it’s a sign of poor nursing care.
As far as the withdrawal of treatment goes, you know that the law is on your side and any discussions they bring up around “withdrawal of treatment” you can refer back to the law.
At this stage you need to continue challenge them on a clinical level and you need to continue asking all the right questions so that they know you can’t be fooled.
Please let me know if you want to talk and I’ll give you a call.
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?