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 13)
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!
Thank you for your last phone call it was again very eye opening to me what needs to be done next!
I have asked my sister if she wants to continue to fight and she nodded her head yes and I asked her if she chose life and she nodded her head yes.
I will continue to do just as you say taking it 24 hours at a time. I will call you with any other changes as it stands I have requested to meet with the doctors, they should let my family know something on Monday if not I will continue to ask for a meeting.
keep pushing for a family meeting sooner than later.
Your sister wants to live she has made that clear over and over again and you and your family want her to live and that’s the bottom line.
The Intensive Care team as well as the cardiac surgeon have a duty of care towards your sister and towards your family, you may have to remind them of that.
Finding out their plans about either doing the surgery soon, later down the track or not at all is important. They are avoiding you at the moment and they need to face you soon!
- 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!
I just left from seeing my sister.
The nurse unofficially told me and my brother-law that the doctors will not perform my sister’s surgery.
She stated that the surgery site that they removed the heart pump from has not healed and that my sister’s surgery would have be open and it would be too “risky”.
Apparently the doctors are trying to get my sister transferred to an LTACH facility but will not be able to at this time because my sister is on the “pressors” whatever that means.
The nurse said that my sister’s insurance is about to run out and that before the doctors will even consider doing surgery on my sister she has to built her strength.
Also the nurse advised us to call around to other hospitals. She said that she doubt that any other hospital will accept my sister, because Methodist is top in the nation.
from a clinical perspective, I can see why they think it’s too “risky” to operate on your sister heart.
What it means is simply that your sister is very weak currently.
She initially had the Intra-aortic balloon pump (IABP) to help her stabilize a weak heart after cardiac surgery.
Once the Intra-aortic balloon pump (IABP) was removed she ended up on high doses of inotropes/vasopressors like the Norepinephrine, the Dobutamine, Epinephrine and Vasopressin. The inotropes and vasopressors are considered life support.
Overall this is not such good news indeed.
- PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE!
It looks to me like your sister’s heart is struggling, which is why they had to either restart some of the “pressors” (also known as inotropes/vasopressors).
Remember last week, your sister was on Norepinephrine, Vasopressin and Dobutamine. Vasopressin came off and Norepinephrine and Dobutamine remained on.
The week before she was even on Epinephrine, another vasopressor or inotrope.
If they are referring that she’s back on four different inotropes or vasopressors they now have her back on the Dobutamine, Norepinephrine, Epinephrine and Vasopressin. She was on all those inotropes/vasopressors a couple of weeks ago and now she’s back on it.
It means the heart is weak again and can’t cope without the drugs to maintain a decent blood pressure.
Vasopressors or inotropes are increasing blood pressure and are also improving the contractility (pump function of the heart). Vasopressors or inotropes are also considered life support in Intensive Care.
As I mentioned previously, a couple of things here, especially with the lower blood pressure (diastolic blood pressure) around 37 mmHg. It suggests that your sister is clinically “dry” and they continue to aggressively remove fluids for mainly two reasons
- To keep the heart “dry” and keep fluids off the lungs because fluids pushing into the lungs from a stressed and overloaded heart may cause breathing/respiratory distress and she may well end up on a ventilator and intubated if they don’t keep her dry
- To manage the kidney failure
They should be doing another Echo/Ultrasound of the heart to find out what’s happening with her Ejection fraction and if the inotropes/vasopressors are at least maintaining her ejection fraction (EF)
With all of this, I am by no means surprised that your sister came close to be intubated and if the inotropes/vasopressors are not improving her heart there is a good chance she will need to go back on the ventilator again.
It could well mean that she has gone back to a point where their initial statements about that she couldn’t live without the intra-aortic balloon pump (IABP) might become a reality.
Why do they only want to meet on Thursday and not today as bringing you up to speed with things would be crucial I believe!
Have you spoken to any doctors at all?
Also, I can definitely be in the meeting over the phone on Thursday.
thank you so much, the doctor’s wanted to do the family meeting on Wednesday but my brother-law is having health issues and had to leave the hospital and will return on Thursday. The doctors are still being very elusive and has yet to give us a meeting time on Thursday.
In the last meeting when I asked the doctors about the ECMO for my sister they told the family that they would not be doing the ECMO because having the ECMO would be a “bridge” for surgery and at that time she was not a candidate for surgery.
My brother-law and family will continue to say no to hospice, palliative care and DNR no matter what the doctor’s say, I am so lost at this point that I really do not know where to start or end. I am afraid if they intubate her again will they be able to extubate her and how long will she last with the “pressors” if these doctors continue to refuse to provide any other type of care, they told the family that once they remove the pump that they would not be able to put the pump back in?
ECMO might also be a bridge to a heart transplant.
I know it doesn’t look good for now, please don’t give up, try and stay positive, it’ll help no matter the outcome.
Yes, trying to avoid intubation will be very important!
And keep making very clear that DNR (Do not resuscitate) or withdrawing treatment are not an option.
- 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!
The “pressors” or inotropes/vasopressors are life saving and keep your sister alive for now. As long as she can’t come off the inotropes/vasopressors, it will be difficult for them to perform surgery, because she is being too weak after all she’s been through.
The cardiac surgeon would see a massive risk by taking her back to surgery, because they would be worried that her heart may not cope with the surgery and she would die.
That’s a possibility and certainly when Patients have cardiac surgery they should have built up their strength prior to it.
Even so, not doing anything is going to be a big risk and I can’t see your sister improving without either doing the surgery or with putting her on ECMO.
ECMO would buy her time and it would give the heart a chance to recover if possible at all.
If the heart doesn’t recover whilst on ECMO, she could be a candidate for a heart transplant.
Keeping your sister off the ventilator would be important, however if the inotropes/vasopressors keep going up it’ll be difficult and she’ll end up ventilated again potentially.
Again, that’s where ECMO could come in. Even though ECMO would most likely require mechanical ventilation and also induced coma, it would still be the best option to buy your sister time.
Those are the questions you need to bring up!
Will try and call you around 4pm your time.
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!
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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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