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 12)
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!
Patrik: Hi Emma. It’s Patrik speaking here. How are you?
Emma: I’m good. I’m in the room with my sister now.
Patrik: Right! How-
Patrik: Is she?
Emma: Well, they took the Vaso; they discontinued the Vasopressin. Now, she’s at Norepinephrine, Epinephrine three and the Dobutamine at five. Her blood pressure goes from the high 90s to 106, 108 over 35.
Patrik: Mm-hmm (affirmative)-
Emma: MAPS is like 64 to 66.
Patrik: Mm-hmm (affirmative)- Mm-hmm (affirmative)- The MAP is the most important out of all of them. The MAP should-
Patrik: The MAP should be above 65.
Patrik: So, if she’s just hanging around there, that’s OK. I’m very pleased to hear she’s off the Vasopressin, that’s really good. Is she talking to you? Can she talk?
Emma: She can talk, but you know, she’s weak. She’s coughing up stuff.
Patrik: Is she a little bit confused?
Emma: Not at all.
Patrik: Great! Great. That’s good. How many hours has it been now since she’s been off the ventilator? How many hours?
Emma: It’s now about from 11:00 to 8:00. So …
Patrik: So, nine hours?
Emma: Uh-huh. From nine to 10 hours.
Patrik: Yeah, that’s good. Is she-
Patrik: She doesn’t look like she’s short of breath?
Emma: No, she’s not. She don’t look it. The nurse said that her blood gases are better now on six litres of Nasal Cannula than it was on the ventilator.
Patrik: Yeah, that’s a good sign. That’s such a good sign. OK. Is she sitting up like, they’re not … You know, because now it’s going be important that they keep sitting her up, if they can and that they keep-
Patrik: Doing chest physio. You know, the physical therapist is continuing to do breathing exercises with her. Do you know whether they have done that today?
Emma: They haven’t. Her bed is about 30 degrees.
Patrik: Mm-hmm (affirmative)-
Emma: The head of the bed. Now, they want her to do the IS, and she’s trying. Look like they set it for a goal of 750, but one time she was about to get 200, but she’s just trying. She’s not really doing anything else, but she’s coughing.
Emma: She’s coughing up stuff.
Patrik: That’s good. That’s good. That’s really encouraging. Tomorrow, if they can … You know, I think one thing you or your brother-in-law may need to push for is physical therapy. That’s going to be really important.
Patrik: She may not be ready to get out of bed yet. She may not be ready to get in a chair yet, but they definitely need to do some breathing exercises with her. Right?
Emma: OK. OK.
Patrik: It’s going to be really important going forward. The other thing, you know, when you’re looking at her blood pressure, what did you say? The lower number was 35?
Emma: Uh-huh. Yeah.
Emma: From 95 over 35 to 108 over 41.
Patrik: Yeah, yeah. So-
Emma: 102 over 40.
Patrik: Mm-hmm (affirmative)- Mm-hmm (affirmative)- That’s-
Patrik: Right, right. That lower number, the 35 to 41, really suggests that she’s dry. So, that means they have been aggressively removing fluids, which I think is good.
Patrik: If the lower number is sort of below 50, it suggests that she’s clinically dry, which you know, again, I think is a good thing because the most important thing for now is they got to make sure the heart can work without the Norepinephrine and without the Dobutamine eventually. That’s the goal. OK?
Patrik: They can only achieve that, for now, if they keep her dry because the more fluids, she has, the less likely the heart can cope.
Patrik: So, that’s why removing fluids is going to be important. Is she very thirsty? Is she sort of complaining about being thirsty?
Emma: She has been. Early, they say she asked for ice, but since I’ve been here, she hasn’t said anything.
Patrik: Right. That’s good. That’s good. Because, you know, on the one hand, they need to wean off … But what’s going to be important for now is they need to wean off the Norepinephrine, if they can. Then, once they’ve achieved that, they need to wean the Dobutamine. Have they done an ultrasound of the heart in the mean time?
Emma: I asked her, and she said, “No.” They only thing-
Emma: They’ve done like the ECG.
Patrik: OK, yep. Yeah. That’s fair enough.
Emma: The nurse just told me that she got a report from the other nurse that they’re wanting to do another family meeting and that the committee and the doctors are going to decide and the accepting doctor, they want to leave. I guess, maybe talk about the surgery, is what the nurse said.
Patrik: OK. OK. When do they want to have the family meeting?
Emma: They’re saying whenever the doctor who accepted her, I guess, is available.
Patrik: OK. I would suggest that if they want to have a meeting, rather than, you know, sort of, you know, the nurse says it could be about potentially doing surgery, I would try and get it from the horse’s mouth, so to speak. I would try and get the family meeting agenda from one of the doctors. That’s what I would do-
- 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: If I was you. Ask the doctors what the meeting is all about, right? Then, get a time, if you can. Ask them what the meeting is all about, get a time, and then you can decide whether you want to go there or not. It sounds-
Patrik: Like, you know, I mean, the meeting will be way more positive than any other meeting you’ve had because now, she’s showing everyone she’s off the ventilator. You know, that speaks extremely loudly.
Patrik: Right? I mean, that’s really … Going from basically them talking about wanting to stop treatment and “pulling the plug” to now, your sister’s off the ventilator, that’s big. She’s made a lot of progress.
Patrik: So, yeah. I would ask the doctors what the meeting is all about. Don’t let them, you know, get it from them crystal clear on what they want to discuss. Right?
Emma: OK, OK.
Patrik: Then, you know, I would suggest get back to me, and then we’ll work out what the next steps are. But clinically, I mean, she’s made so much progress, and now, the challenge is to wean off the Norepinephrine and wean down the Dobutamine. I really do believe they need to do an ultrasound sooner than later.
- 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!
Patrik: The reason I think it’s so important to do an ultrasound is … They get another injection fraction. Do you remember that?
Patrik: Right! So, they will get another injection fraction. I would think that her injection fraction has improved.
Patrik: I would imagine it has improved. Otherwise, they wouldn’t have been able to wean the Vasopressin and the Norepinephrine, right? So, her injection fraction must have been improved.
Patrik: Now, given that there will be some new numbers, if her injection fraction has improved, they should be able to reduce the Dobutamine as well. That should be their next step.
Emma: OK, OK.
Patrik: Right? The ECG or the EKG will show them a little bit, but it won’t show them an injection fraction, and they need to find out the injection fraction in order to see whether they can reduce the Dobutamine or not.
Patrik: The steps really are they need to start physical therapy. Have you seen they doing physical therapy at all over the last two weeks?
Patrik: Right. Have you asked for that? Have you asked them if they’re doing it? If they’re not doing it? Have you asked that question?
Emma: I have, and at one time, she said that as soon as they get those drips down, they will have her come in and try to build up her upper extremities to help with her breathing.
Patrik: Mm-hmm (affirmative)- Well, I think you need to ask again.
Patrik: Because I think that’s going to be really important going forward. So, the physical therapy will be important to do the breathing exercises to strengthen the breathing muscles, and it’ll also be important to get, you know, to move arms and legs, eventually, sit her on the edge of the bed, and eventually, sit her in the chair.
Patrik: Right? That’s all going to be very important going forward.
Patrik: No matter what they decide with surgery, you know, they need to build up her strength. Whether they decide to do surgery or not, doesn’t matter.
Patrik: She’s come a long way. I mean, I’m so pleased.
Emma: Me too. Thanks. I’m so grateful to you.
Patrik: Oh, you’re very welcome. You’ve kicked their bum. You have. That’s the result for now, and that’s really good. So, yeah. Have you, today or yesterday, have you spoken to a doctor at all or just to the nurses?
Emma: Just speak to nurses because the weekend doctor was scarce, and I had to go back to work this morning. So, my brother-in-law’s been here, and they haven’t talked to him either. So …
Patrik: Right. OK. Well, I mean, for now, the result is way more important than talking to them because she’s in a much better position now for anything, right? But the next steps are physical therapy, you know, discussion about surgery, and weaning the Dobutamine and the Norepinephrine. If she can do all of that … Once the Dobutamine and the Norepinephrine are off, it means her heart is beating without any support.
Patrik: Right? So-
Patrik: Pretty much in the last 24 hours, they have to support. Right?
Patrik: With the Vasopressin off and the Norepinephrine, pretty much half the support already in the last 24 hours. So, that’s good. Also, in terms of life support, as long as she was on the ventilator, ventilation is life support. OK?
Patrik: So, if the Norepinephrine and Dobutamine are considered life support as well-
Patrik: The dialysis is life support. But again, one form of life support has been removed. That’s good.
Patrik: So, she’s only on two forms of life support now, which is the Dobutamine and the Norepinephrine and the dialysis. So, you know, it’s good if they can take off life support because one the Dobutamine and the Norepinephrine are off, the only life support is the dialysis, but she’s been on dialysis for a long time. So, we’re not really worried about the dialysis.
Emma: Right. OK.
Patrik: Right? So, the next step really is making sure she can stay off the ventilator, breathing exercises, physical therapy, an ultrasound so they can check her injection fraction, and then hopefully, they can remove the Norepinephrine and the Dobutamine, preferably slowly. Not in 24 hours but maybe over the next 48, 72 hours. I mean, that would be very good.
Emma: OK. OK. So, in the meeting, just get the agenda and see what they’re talking about-
Patrik: I’d say so. I’d say so. I’d say get it from the horse’s mouth, listen what they want in the meeting. I would be very happy to call into the meeting over the phone. Very happy to be there.
Emma: Oh, good. OK, OK.
Patrik: Right? So, there’s no issues around that. Yeah, and I’ll flick you a quick e-mail just to summarise what we’ve-
Patrik: Talked about, so you’ve got it in front of you.
Patrik: Was there anything else?
Emma: That’s it!
Patrik: That’s it for now? That’s really good. I’m so pleased. I’m so pleased.
Emma: Me too. Taking it 24 hours at a time!
Patrik: Yes, yes. Still, still. But you can see the next steps. You can see them, which is really important.
Patrik: OK. I will flick you an e-mail. If you need-
Patrik: Anything in the meantime, please yell out. Anytime.
Emma: OK, OK. Thank you so much.
Patrik: You’re very welcome. All the best for now.
Emma: OK. Be safe. Thank you.
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?
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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!
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