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 questions from one of my clients, Iyah, as part of my 1:1 consulting and advocacy service! Iyah’s dad is critically ill in the ICU and she is asking what are the right questions to ask the doctors while her dad is in the ICU.
What Are the Right Questions to Ask the Doctors While My Dad is Critically Ill in the ICU?
Patrik: Hi Iyah! How are you?
Iyah: Hello? Hello? I’m good.
Patrik: Between when we spoke last time and now, have you had any further updates?
Iyah: I did ask the ICU nurse if I can add you as a contact person.
Patrik: Okay. I think what we need to do as a next step when we call them, I’ll make sure I’ll be very non-threatening to them, just asking some questions and then we can see where we are going.
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Iyah: Yes. Is it best to make a three-way call? I do have the hospital’s phone number.
Patrik: I think it’s best to make a three-way call. Do you want to call them now?
Iyah: Yeah, now will be good. I’d like to try to get the ball rolling. I’m not familiar with making three-way calls, but I do have their phone number. Are you pretty familiar with-
Patrik: Yeah. I’ll tell you what we’ll do, Iyah. I will get off Skype. I’ll call you on your phone, and then I’ll dial the hospital number in.
Iyah: Okay.
Patrik: That’s the best way to deal with it. So, just give me a couple of minutes. I’ll call you on your cell phone and then we’ll call the hospital in.
Iyah: I do have the phone number. Would you like to write that down now?
Patrik: Yes, I might as well. Just give me a second.
Iyah: Sure.
Patrik: And before we call them, who will we get on the phone most likely?
Iyah: The ICU nurse.
Patrik: And that is the nurse that’s looking after your dad or is it the nurse-in-charge?
Iyah: The shift. Yes.
Patrik: Yeah. Not the nurse-in-charge. The nurse that’s looking after your dad directly?
Iyah: Actually, it’ll probably be the charge nurse. Yeah, I think you’re right. It would be the charge nurse.
Patrik: Right. So, when you talk to them, you never speak to the nurse that’s directly looking after your dad?
Iyah: It’s always in person, when I’m visiting. I haven’t called to ask questions or anything.
Patrik: I see. I see. Okay. So, you think when we call that number, we’ll get the nurse in charge?
Iyah: Yep. I’ll ask for the critical care one nurse.
Patrik: Okay. You start the conversation and then you gently ease me and say, “Hey, by the way, I’ve got Patrik on the phone. He is a family friend, he’s also a critical care nurse. He’s just trying to help me understand what’s happening and he’s helping us to make decisions.” That way it stays non-threatening. And from there, and it looks like… I mean, they want to have a solution. So, from their end, then it looks like, well, I’m trying to help them as well.
Iyah: Yes.
Patrik: Yeah. I’m not calling them up without you on the phone. There’s a big difference there.
Iyah: Right.
Patrik: All right.
Iyah: And may I ask… Yes, go ahead.
Patrik: Please. No, no, you go. You go.
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Iyah: May I ask what questions you may be asking?
Patrik: Yeah, I’ll be more or less asking questions from head to toe. So, what that means is I’ll almost be approaching it in a way that if I was working there and if I was to take handover from them, that’s the way I approach it. Almost like a nurse-to-nurse handover. And then, they can see that I know what I’m talking about, and that’s the best way for me to get information. So, it’s really starting from head to toe. What that means is, for example, when you start from head to toe, asking about the neurological condition, is your dad awake? What’s his Glasgow Coma Scale? What sedation is he on? And so forth.
And then, going all the way down. The next system then is the cardiovascular system. “How is the heart? Is he on any medications for his heartbeat, for his blood pressure? Is he having a temperature? What are blood results like?” And then, I move along to the respiratory system, “What ventilator settings is he on?” And then, once we’ve gone through the ventilation side of things, then I’ll move it down towards nutrition. And then, once we’ve done nutrition, we go to the kidneys. And once we’ve done kidneys, we look at does he has any sugar issues? Is he… A lot of patients-
Iyah: He’s diabetic. I forgot to mention he’s diabetic, type 2.
Patrik: Right. That’s okay. That’s okay. So, he might be getting insulin while he’s in ICU. Was he on insulin before?
Iyah: Yep. Yep.
Patrik: Right, so his sugar might be all over the place.
Iyah: Around 100, 200.
Patrik: Right. Okay. That’s the way I approach it. And that’s the quickest way for me to get information and approach it in a logical and also chronological sense. If you want me to, I can record that call and then you can, also, going forward, ask those questions. I mean, part of what I do is ask questions, but I can record it and then you can go back to it, and then you can ask the questions yourself. I guess the advantage of me asking questions is that depending on the answer, I can ask counter questions.
Iyah: Yeah. And I’d like to mention my younger sister had a bunch of messages she wanted relayed. And I had mentioned his pH level was a smidge off, and my sister mentioned the food he’s getting is… What is it called?
Patrik: Oh, alkalotic?
Iyah: Alkalotic. Let me just pull it up really quick. These may be things that are concerning to keeping his body not in an alkalotic state. The nutrients from the protein and sugar, which are acid-based. And arguing that he would need more alkaline-forming foods. Is that something that may sound reasonable to ask?
Patrik: Yeah. I’ll ask about his blood gases because they can determine whether he’s alkalotic or not in a blood gas. And it’s probably got everything to do, potentially, with his kidneys. I wouldn’t-
Iyah: He only has one kidney that was transplanted years ago, that’s now failed because he hasn’t peed in weeks. Or since his stay, since his hospitalization.
Patrik: And you are certain that it’s alkalosis, not acidosis?
Iyah: Oh, I don’t know. My younger sister was saying because his pH is slightly off, maybe the medicine he is given is acid-based, his food is maybe acid-based. That’s what she said. I don’t know.
Patrik: Yeah, sure. Look, that’s something we can find out.
Iyah: Yeah, she just said they’re not giving him anything that is alkaline-forming foods.
Patrik: Right. Okay.
Iyah: Yeah. And she’s saying this causes more perceived end of life, which is arguable of neglect and malpractice upon the doctors and nurses, something like that.
Patrik: I wouldn’t be able to tell you that. I need more information.
Iyah: Oh, one sec. Another thing was a concern about fentanyl, what is it called?
Patrik: Fentanyl?
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Iyah: The pain pills. Fentanyl. So, he’s given fentanyl and I asked if there was an alternative, and I was told, “No,” by the nurse this morning, “there’s no alternative.” I understand from your videos, those pain pills have withdrawal issues and such, and a hard time waking up. With your expertise, is there an alternative to fentanyl or benzodiazepine?
Patrik: Yep. There are alternatives, however, it really depends on why they’re giving it.
Iyah: It’s because of his heart.
Patrik: So, the next question is why are they giving it? And we’ll find that out on a call because everything else would-be speculations from here. One of the reasons one needs to do a tracheostomy is to reduce drugs like fentanyl or benzodiazepines. That’s one of the reasons one might have a tracheostomy, to eliminate the need for that. But one of the main questions to me is what have they done to this point to try and avoid the tracheostomy?
Iyah: Wean him off the sedative-
Patrik: Yeah, but what I’m saying is I want those questions answered by them.
Iyah: Yeah. With the fentanyl, they only give it when his heart rate spikes up to 160.
Patrik: Yeah. I think what we need to do is really talk to them and get it from the horse’s mouth, so to speak.
Iyah: Yeah. And from this morning, it was 50 mcg of fentanyl. 12 is a low dosage from what the nurse said, which they started off-
Patrik: Is that 50 mcg per hour or is it just a one-off bolus?
Iyah: When needed. When his heart really spikes up.
Patrik: When needed? Okay. Yeah. So, it’s not an hourly dose?
Iyah: Correct. Correct.
Patrik: Right, okay.
Iyah: So, those are our concerns and my sister and I, the pain meds that are keeping his lungs from working.
Patrik: Yeah. And from your perspective, who is pushing for the end of life? Is it the nurses? Is it palliative care? Who’s pushing for that?
Iyah: Palliative.
Patrik: And who is that? Is that a nurse practitioner? Is it doctor? Is it specifically-
Iyah: A doctor.
Patrik: A doctor?
Iyah: It’s a doctor. I do have his name.
Patrik: Right. Okay. All right. Look, I’d say let’s try and call them in unless you think there’s anything else that’s important before we call them in?
Iyah: What are your thoughts on the benzodiazepine? I hear bad things about-
Patrik: I’ll tell you what my thoughts are. My thoughts are that it all depends on what’s exactly happening.
Iyah: So, along the lines of the fentanyl is whenever he needs it?
Patrik: It all depends on the bigger picture. At the moment, we’re trying to piece together a puzzle. Once I understand everything that’s happening from head to toe… Until I’ve had an understanding what’s happening from head to toe, I’m speculating. I’m not in the business of speculation. I’m in the business of combining facts to a conclusion. There are too many moving pieces when someone is in intensive care and the only way to puzzle those pieces together is by talking to the clinicians.
Iyah: Gotcha. Yes. One other thing is he’s getting infusions of-
Patrik: Dexmedetomidine?
Iyah: Yes.
Patrik: Precedex? Yeah, okay.
Iyah: Yeah, he’s getting 2.5 or 25.8.
Patrik: Right.
Iyah: Okay, sounds good.
Patrik: I’d say we’ll talk to them and get it from the horse’s mouth. And then, we’ll have a better understanding because I think that’s probably the next step.
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Iyah: Okay. Should I stress the concern of his being on ventilation for long period and-
Patrik: No, not yet. Because again, we need more facts. There may well be a reason why they’re doing what they’re doing.
Iyah: Yes. Yeah.
Patrik: That’s why… I don’t want to throw out the baby with the bath water. At the moment, we’re just speculating.
Iyah: Okay. So, I’ll just introduce myself and say, “I have my friend Patrik here who is-”
Patrik: That’s right.
Iyah: … “an ICU nurse experience. And we have some questions that we would like to ask.”
Patrik: That’s exactly right. Yeah, and we’ll deal with it if they refuse that, but I really doubt it. I really doubt it.
Iyah: Okay.
Patrik: All right. I’ll let this call go, and I’ll call you on your cell phone.
Iyah: Okay.
Patrik: Thank you. Thank you.
Iyah: You’re welcome.
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
- 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
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- 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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