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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
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 the succeeding questions from one of my clients Peter as part of my 1:1 consulting and advocacy service!
Peter is saying that the ICU team is stopping the treatment to his dad and that he wants to transfer him to another hospital.
The ICU Team is Stopping Treatment to my Dad in the ICU. Can I Transfer Him to Another Hospital?
“You can also check out previous 1:1 consulting and advocacy session with me and Peter here.”
Patrik: Per hour?
Peter: 7.2 milligrams per hour.
Patrik: That’s sort of an average.
Peter: 7.2 milligrams an hour.
Patrik: Right. That’s sort of an average. Right. That’s sort of …
Peter: And then it says 26.39 hours, not minutes.
Patrik: Right. Right.
Peter: So, I guess it’s 26 hours, 39 minutes.
Patrik: Right. Right. I guess …
Peter: And then it has the volume to be delivered, VTDI, right?
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Patrik: All he needs is 190.
Peter: 190
Patrik: It’s the most important, it’s the need for now. Okay. Here is what I can see. If you are getting a second opinion or if they are getting a second opinion tomorrow, you are probably absolutely accurate to say that they probably will cover each other. You’re very accurate there. I do believe what they probably want to work towards is a DNR and withdraw life support. That’s probably what they want to work towards. But you know, on the positive side, given that they are giving the ventilation and that they are giving the norepinephrine, they are continuing. You know, that’s the positive that I can see.
Peter: Well she said to me today, “We don’t think he’s going to improve.”
Patrik: Right. And when have they..
Peter: It says his creatinine is 5. His creatinine is 5. And they don’t think his kidney’s gonna improve.
Patrik: Right.
Peter: But all of … like, his electrolytes are okay.
Patrik: Yeah.
Peter: So I mean, the doctor told me that some part of his kidney’s working.
Patrik: Right.
Peter: And the doctors are … the nephrology doctor told me that he thinks that if he waits, that the kidney might start peeing again.
Patrik: Right. Yeah, absolutely. What do you think … what do you think? If he goes to another hospital, what do you think would change?
Peter: Well I hope that … if I got him into the VA, you see I used to work for the VA myself, and believe it or not, I used to work in the dialysis unit.
Patrik: I see. Yeah, no, no, you told me. You told me.
Peter: Yeah, and I talked to the chief over there about this.
Patrik: Okay.
Peter: And he says “Well, you know …” he says, “You first have to get him into the hospital.” He says he has no control over getting my father into the hospital, he said “you have to get him through … he’s gotta come through the emergency room” or something. They have to have a free room in the intensive care. There’s no free room right now.
Patrik: Okay.
Peter: ‘Cause nothing’s freed up.
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Patrik: Right. You know what I would do, Peter, if I was you, I would–if you want that, I would call the bed manager at that hospital. The bed manager always has an interest to fill their beds. Get it from the horse’s mouth. Get it from the bed manager.
Peter: Yeah, I did that once before.
Patrik: Right.
Peter: And they were holding those beds for veterans that come in in the emergency room.
Patrik: Okay.
Peter: I remember just specifically and she wouldn’t hold him for … well I tried to get Dad transferred a while back for another issue, and they wouldn’t do it. They were holding those beds for the veterans at the emergency room, transfers from other hospitals. They’re real snitty.
Patrik: Okay. Okay. How often have you tried? Once?
Peter: Well, I’m gonna try again tomorrow.
Patrik: I would. I would.
Peter: If the doctor hasn’t …
Patrik: I would. You know, I mean, the situation might have changed …
Peter: What’s your policy down there? Patrik, down there is … is that the policy? What do you guys do and do you go right to dialysis in the ICU, or …
Patrik: Pretty much. Pretty much. Okay, so normally what you do is, when a patient goes into kidney failure, you definitely start with the furosemide. Okay. So if the furosemide isn’t working, then you go on to the dialysis. However, there is another scenario. Let’s just say you are giving the furosemide, and the furosemide is working. The kidneys might still fail. What that means is, you’re giving furosemide, for example, and you achieve a good urine output, but your urea and your creatinine are still climbing. Right? So that means the furosemide might be working but the kidneys are still failing in essence, right? And if that’s the case, you still get somebody on the dialysis machine then.
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Peter: Yeah.
Patrik: Is he making any urine at all at the moment?
Peter: Well today he put out about 300.
Patrik: That’s pretty good. And that’s on furosemide?
Peter: Yeah, but they stopped it early this morning. But he put out some urine and then he stopped. I sometimes think that the guy is actually dehydrated.
Patrik: Oh, he probably would …
Peter: They don’t want to give him any water, because of his lungs.
Patrik: Yeah. Yeah, he probably …
Peter: That’s my thought.
Patrik: Yeah. You’re probably right. He probably is dehydrated.
Peter: You know what I’m saying?
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Patrik: Absolutely. Absolutely. There’s a very high chance he’s dehydrated.
Peter: So I mean, I don’t know, I just thought I’d …
Patrik: Yeah, no, look …
Peter: So I mean …
Patrik: I think from everything that you’ve shared, Peter, they are doing everything they can. However, especially with a second opinion coming up, I would assume that they are trying to push towards stopping treatment, right? I mean, it’s not rocket science that that’s probably what they’re aiming for. So, from my perspective, for now, I think he’s safe. But if you think he’s better off going to that other hospital, then I would, if I was you, I would be making some phone calls.
Peter: Yeah, you know … and the thing is too, Pat, is … my concern is, if they don’t want to help him, he’s got a bridge to nowhere there.
Patrik: Right.
Peter: I mean, it’s like, it’s wasting time.
Patrik: Right.
Peter: You know what I’m saying? We’re wasting time.
Patrik: Yes, you’re right. You’re right.
Peter: Unless the doctor says to me tomorrow, “Look, here’s what we’re gonna do. If his creatinine goes higher or if he doesn’t whatever, we’re gonna try dialysis but it’s your responsibility if something happens to him …” but they don’t think like that.
Patrik: Right. Right.
Peter: It is some sort of, “we think it’s immoral,” she’s … I’m gonna put it on paper too. That it’s immoral that we continue to make him suffer more, and all this stuff here.
Patrik: Well …
Peter: I mean, you know, I mean, a lot of guys on dialysis that, even if they, okay, put it this way. If something happens to the poor guy, then at least we tried. You know?
Patrik: Do you think …
Peter: But the other doctors … go ahead.
Patrik: Do you think he’s suffering?
Peter: Well it’s not … it can’t be comfortable to have your lungs filling up with junk, you know, and having that machine pumping you up. In that sense there I think he’s suffering a little, but I mean, I’m trying to get him across a difficult bridge, you know?
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Patrik: Of course.
Peter: I mean, I’m just trying … I mean, my hope is that the dialysis, from what I read … maybe I’m wrong, but it’s just a temporary, just until the kidneys rest, and buy him some time.
Patrik: Right. How long …
Peter: It’s not like he’s chronically …
Patrik: Right. How long was he off the dialysis machine before he went back on again? How long was he off?
Peter: He never got on it. They won’t let him get on it.
Patrik: Okay. Okay. Well … I mean, I think that’s … I think that’s what you should be pushing for. Ask them what his urea and creatinine is. And … but I believe he is dehydrated. By everything that you’ve shared, I think he is dehydrated.
Peter: Right. And they say, “Well …” oh, go ahead. I keep stepping on you. Go ahead.
Patrik: You know how you can find out? You know how you can find out if he’s dehydrated or not, in ICU, they’re doing a fluid balance every day. Probably around midnight, they’re doing a fluid balance. Ask them what his fluid balance is like. So, let’s just say if he’s been negative for five days, for example, he’s dehydrated. Does that make sense?
Peter: Well either he’s dehydrated or it’s not coming out. It’s blocked somewhere. It’s going someplace else like his lungs or into his cavity.
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Patrik: Yeah.
Peter: I mean, couldn’t that be true also?
Patrik: Yeah. But you can find out. Ask them what his fluid balance was like over the last week.
Peter: You mean ins and outs, when you say “fluid balance?”
Patrik: Yes. Yes. In and out. In and out. So basically, once a day, they are adding up, they are calculating a fluid balance. Basically, what it means is they’re adding up input and they are taking away output. And then you have a fluid balance. Right? So, it’s fairly simple. But if you ask them …
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Peter: Yeah, and the creatinine … the doctor at the VA that I used to work for, he told me that … Dad’s creatinine is about 5, and he said that there was no way that he could … you need dialysis with a creatinine of 5.
Patrik: Probably.
Peter: He said he would wait till he got to 14. Way up there, he said.
Patrik: I agree. I agree. 5 is nothing. 5 is nothing. I do think, Peter, you could wait. Until they’ve had this review. But if you think the review is getting you nowhere, if you think the review is just a way of trying to stop treatment, if that’s not what you want, then you might have to look at another hospital. But I think …
Peter: It’s such a pain in the ass transferring him. And I did it before going from the other hospital. You know, ’cause then you gotta get the air mattress..
Patrik: Yeah. How far away is that other hospital?
Peter: Up the street. It’s like, the VA hospital is about 10 minutes from where we are.
Patrik: So not too bad. It’s not in another city.
Peter: No, I used to work in that intensive care unit. Like, the same type you worked in. I was a dialysis technician. And we had done dialysis on people right out of the OR with their chests wide open and you know, the wires, the drain tubes, and dialysis techs. These guys, I mean, I never thought they’d survive.
Patrik: Right.
Peter: And then two weeks later I go up there to do dialysis on another guy, and then “Hey, where’s Joe who was over in the corner?” “Oh, he got discharged. He’s doing all right.” I say “You’re kidding me.” He says, “No, no,” the nurse would say, “you know, the body’s an amazing machine. It can take a lot of punishment.”
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Patrik: I agree. I agree. People are very resilient. People are very …
Peter: My father, I mean, he..and my father’s like that. He sits there, opens his eyes, he looks around, and like today, when I asked about cutting back on the Keppra, I think it helped him. ‘Cause that was just making him more tired.
Patrik: Right.
Peter: Johnny, was Dad’s eyes open when you … see, my brother just came home.
Much more than yesterday, right?
Patrik: Right.
Peter: Yeah, I mean, the side effect though is that he’s gonna be more twitching, but so what?
Patrik: Of course. Yeah.
Peter: Go ahead. I’m just spilling my guts here. I don’t know.
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Patrik: I think, Peter, by everything that you’ve said, I don’t believe they’re not doing their best at this stage. I mean, I don’t have the bigger picture, but that’s why I asked you about life support and stuff. I have no concerns that they’re not keeping your dad alive at this stage. If he’s only getting 800 mils an hour, I don’t think he’s fluid overloaded. I think he is dehydrated. ‘Cause 800 mils is nothing.
Peter: Oh no, the 800 mils, that’s over 24 hours.
Patrik: Yeah, yeah, it’s nothing. It’s nothing. It’s a drop in the ocean. It’s nothing.
Peter: I mean, that’s not a lot, right? I mean, that’s like, if you divide that 24, it’s 40 cc’s an hour.
Patrik: That’s right. It’s nothing. So …
Peter: It’s ridiculous.
Patrik: It is.
Peter: And they cut all his water, so no wonder he’s not putting out any urine.
Patrik: So you know, from that perspective, it might well be accurate that they are not doing dialysis. Right? Urea is 5, that’s …
Peter: Oh yeah. I know, she quote the kidney doctor saying that to her.
Patrik: Right.
Peter: The kidney doctor was afraid, and he told me a story about dialysis. If they do it too soon, he said, and they try to pull that fluid off, he says then it might actually damage the kidneys more.
Patrik: It might.
Peter: You know, it could cause the blood to get pushed into the kidneys when it’s all … will then clog up the kidneys, but I mean, if he’s not … if the kidneys ain’t working, then, I don’t know. I mean, there’s gotta be an answer to this.
Patrik: Yeah. I think, I do believe, by everything that you’ve shared, Peter, I would wait for the weekend. It’ll be much easier probably to transfer your dad on a weekday. I would wait for the weekend and see what the next steps are, and then if you think they’re not doing the right thing, then you could look at getting him to another hospital. But I would wait for a couple of more days. I have no indication, from what you’ve shared, that they’re not trying.
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Peter: Yeah. Well anyway, I was just figuring like, maybe there’s a way to … maybe I’ll get the ball rolling though.
Patrik: I think you should, I think you may, because number one, it gets you on their radar. Right? And even if they say no, they know you’re looking, and then you probably might have to make another phone call. Right? And if it’s only up the road, I mean, you could even go there. You know, I mean, sometimes being there in person helps as well.
Peter: Yeah, but … you know, I mean, of course to go there. But I think the trick is, though, depending on what she tells me tomorrow, if she’s gonna stonewall me and give me the old, you know, then I’m gonna … see, because it takes time to get him transferred. You know, I can say … during the week, it might be easier, but you gotta get the ball rolling early though. You can’t … ’cause you gotta wait for a spot too, you know?
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Patrik: Right. Okay Peter, I’ll give you a quick example, okay? Last week, exactly a week ago, I had a client that was looking for a bed in another hospital. Okay? So the client was in ICU, and the client wasn’t happy at all. Okay, so I should say the family wasn’t happy at all. I made some inquiries. Within five hours, we had a bed in another ICU, and within 24 hours, the client was in that ICU. So you never know … if they have a bed, and if they have an interest in filling their bed, they will take your dad. So you can never assume anything. You can only try.
Peter: Yeah. I mean, I just don’t want to have him in a dead-end…
Patrik: Of course not.
Peter: You know, just sit there and watch him die, you know?
Patrik: Of course not. But what I’m saying, you know, it is possible, and just because they say no today doesn’t mean no tomorrow.
Peter: Yeah. Or you know what she meant … I had a good question for you. You might know this. This doctor refuses to use … what’s that antibiotic that begins with a V? I don’t know why I keep forgetting it.
Patrik: Vancomycin?
Peter: They will … vancomycin.
The 1:1 consulting session will continue in next week’s episode.
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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- How to ask the doctors and the nurses the right questions
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- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
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- 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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