Fentanyl Overdose, Severe Anoxic Brain Injury and ICU: What are the Options? Quick Tip for Families in ICU!

“Fentanyl overdose, severe anoxic brain injury, and ICU: What are the options?”

My name is Patrik Hutzel from intensivecarehotline.com, where we help families of critically ill patients in intensive care to make informed decisions, have peace of mind, control, power, and influence, even if you’re not a doctor or a nurse in intensive care, so that your loved one always gets best care and treatment.

In today’s video, I want to answer a question from Heather, who writes,

“My daughter is 24 and had an overdose on fentanyl, and they found she had a severe anoxic brain damage to the basal ganglia area. She’s been in ICU now for 3 weeks. She’s got a tracheostomy and a PEG (Percutaneous Endoscopic Gastrostomy) tube and is now breathing on her own with a tracheostomy mask. She’s showing signs of alertness like reactive pupils, and posturing.

As of now, she opens her eyes but doesn’t respond intentionally. She also recently got a blood infection due to a PICC (Peripherally Inserted Central Catheter) line that has been removed and is causing her fevers. The doctors say the fever could also be due to neurological issues. She’s been given Precedex and oxycodone as well as midazolam/Versed.

No seizures have been found after the EEG (electroencephalogram), but MRI (Magnetic Resonance Imaging) shows damage to the basal ganglia. They are talking about moving her to a LTAC (Long Term Acute Care and I’m worried about the outcome. What can I do in this situation?”

This is from Heather. Obviously, Heather is in the U.S. because she’s talking about LTAC.    LTAC is unique to the U.S. LTAC stands for long-term acute care hospital or long-term acute care facility. It’s often where ICUs in the U.S. want to move patients as soon as they’ve got a tracheostomy and a PEG tube.

So, but let’s break this down. First of all, Heather, I’m really sorry to hear about your daughter’s situation, it is incredibly difficult. But let’s also look at some positives here. Your daughter’s only 24 years of age, which is a good prognostic factor when it comes to recovery from severe brain injury. She’s breathing on her own with a tracheostomy mask, which shows she has respiratory drive and strength. Her pupils are reactive and she’s opening her eyes. These are very encouraging signs.

Now, there are a few important things to keep in mind. Number one, sedation and pain medications. She’s on Precedex, which is also known as dexmedetomidine, Versed, which is also known as midazolam, and she’s on oxycodone. All of those drugs suppress neurological function, so the ICU team can’t truly assess her level of brain function until those medications are minimized or even stopped. That’s really important to point out.

Also, now that she’s got a tracheostomy, all opiates and benzodiazepines should be stopped. The said midazolam is a benzodiazepine and oxycodone is an opiate. All of that should be stopped, but even Precedex should be stopped. One of the main reasons someone has a tracheostomy is to stop all sedation and all opiates. So, they’re really defeating the purpose of having done the tracheostomy.

What you see in ICU is not always what you get. If you don’t know what to look for, if you don’t know what questions to ask, you are fighting an uphill battle.

The biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

Next, your daughter’s fever. Yes, neurological fever is a possibility in brain injured patients, but given that your daughter had bloodstream infection from the PICC line, it’s much more likely that the infection is still causing the fever. This needs aggressive treatment with antibiotics.

Next, LTAC. This is where I want to caution you. LTACs, also known as long-term acute care facilities or long-term acute care hospitals, are often a step down from ICU and the level of care is simply not the same. The level of care is simply dangerous. Many families regret moving their loved ones to LTAC.

Alternatives exist, such as Intensive Care at Home, and you can find more information at intensivecareathome.com, where patients can receive ICU-level care at home with 24/7 intensive care nurses. This is actually the best evidence-based approach for a situation like your daughter, and it’s often a much better option, especially for young patients with long recovery potential. You can check out our service at intensivecareathome.com.

Next, prognosis. Recovery from anoxic brain injury is a long process. It’s not measured in days or weeks. It’s measured in months and often years. Many young patients have surprised doctors by achieving far more than expected, but families often need to slow down the process, keep their loved ones safe, and give time for recovery.

So, what should you do? Insist on a proper neurological assessment—off sedation, off opiates. Track the Glasgow coma scale (GCS) regularly. Get early neurorehabilitation input. Do not rush into LTAC without understanding all the implications. Explore Intensive Care at Home as an alternative. I know, Heather, this is a lot to take in, but you are already doing the right things by asking the right questions and by seeking advice.

If you’re watching this and you have a loved one in intensive care with severe anoxic brain injury or any other critical illness, you need to help navigating this, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or simply book a call with me on the top of the website, or simply send us an email to [email protected].

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section, where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel or my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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