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

If you have a loved one in intensive care with a coma, tracheostomy, or on a ventilator, and you’re getting mixed messages from the doctors and the nurses, this video is for you.

I have a question from Chiquita, one of our clients, who says,

“Hi Patrik,

I gathered some information. My sister is still in a coma. I was told that the sedation ended about 7 days ago. However, my sister is still on seizure medications which include Keppra, Vimpat and Valproate. One of the doctors says that my sister’s brain waves are slow on the EEG (Electroencephalograph), like in a sleep state. I spoke to another doctor who says that sedation can slow brain waves. My sister’s overnight nurse informed me that my sister has gag reflexes, corneal reflexes, and a cough. She also flickers her eyes. The night nurse also stated that my sister appeared to be trying to awaken from the coma, however, the day shift nurse said that she saw nothing.

When I asked about the medication that my sister was given, the day nurse stated that my sister was given 3 seizure medications. My sister woke up every day after her cardiac arrest until she was given seizure medications. The one doctor who was supportive stated that it takes longer for dialysis patients to feel their drugs. Because he has been off duty and the doctor who is covering him is bad. My sister’s CT scans came back to normal every time, however, her EEG reveals sluggish brain waves. According to the ICU doctor, because she has not awakened, she is in a vegetative state. I told the ICU doctor that the night nurse said that my sister tried to wake up, but she said that didn’t mean anything.

My sister woke up days after the cardiac arrest, but after taking seizure meds, she has not woken up at all. Is it possible for a person to never awaken from a coma? I spoke to a surgeon, and he told my mom that my sister was still sedated. By the way, my sister flickers her eyes when I talk to her. She also positions her legs in the way she was.

From Chiquita.”

Chiquita, that’s a fantastic and very important question, and it’s one I get all the time at intensivecarehotline.com. First of all, let’s unpack this step by step. Sedation versus seizure medication, even though sedation stopped 7 days ago, seizure medications like Keppra, Vimpat, and Valproate can absolutely still suppress brain activity and slow EEG patterns, especially when given in combination and even more so in dialysis patients, because the kidneys can’t clear those drugs quickly. Yes, the seizure medications can make it look like your sister is still sedated, even though the ICU team says sedation has stopped. It’s also showing that the CT scan of the brain looks normal. So what would have changed besides giving anti-seizure medications?

Next, reflexes and eye flickers are positive signs. You mentioned your sister has gag, corneal and cough reflexes, eye flickers, and leg positioning. Those are all brain stem reflexes, meaning her brain is functioning at a basic level. That’s not a vegetative state. In a true vegetative state, there are no purposeful movements and no consistent brain stem responses. Maybe there is some eye opening, but most of the time there’s not even eye opening. What you’re describing suggests she’s not brain dead and not necessarily vegetative, she may simply be in a prolonged state of reduced consciousness due to medications, metabolic issues, or the aftereffects of cardiac arrest.

Another good indicator for whether your sister’s in a vegetative state or not is the Glasgow Coma Scale (GCS). It doesn’t sound to me like your sister is a Glasgow Coma Scale of 3, which would basically indicate that she’s in a vegetative state. If she’s coughing, if she’s opening her eyes, if she’s moved, she’s above a GCS of 3, and that means she’s not in a vegetative state. She may appear to be in a vegetative state because of all the sedatives she’s getting and all the anti-seizure medications, and maybe because the sedatives and the opiates are not washed out of the body as yet, but other than that, there’s no sign she’s in a vegetative state. Go and check out what Glasgow Coma Scale means. I’ll put a link in the written version of this blog.

Next, EEG is sluggish or slow brain waves explained. An EEG slowing, showing slow waves doesn’t automatically mean severe brain damage. It can also reflect drug effects, especially seizure medications or sedation, metabolic factors like kidney failure or electrolyte imbalances, sleep or recovery state. The EEG must always be interpreted in context, not in isolation, and like you have pointed out, the CT scan of the brain showed no abnormalities.

Next, mixed messages from ICU staff. It’s very common that night shift nurses observe different things than day shift nurses simply because patients’ responsiveness can fluctuate. What’s more concerning is that you’re being told conflicting stories, one doctor saying she’s vegetative, another saying she’s sedated. That tells me you need a clinical advocacy approach, someone who can look at the chart, medication lists, EEGs, and lab results independently and explain what’s really happening. That’s exactly what we do here at intensivecarehotline.com. We provide independent consulting, independent advocacy for families in intensive care like yours, making sure you get the real picture, not just the hospital’s often negative and doom and gloom narrative.

Your next question was, can a person ever wake up from a coma? Yes, some patients do not wake up, but in my experience, many families are told it’s hopeless, it’s never going to happen, it’s far too early. It can take days, weeks, months, sometimes years. I’ve seen patients wake up after many days, weeks, months, even years, especially once sedation and seizure medications are reduced or stopped. The question is, are the doctors doing everything they can to minimize sedation and seizure medications without your sister suffering and without your sister having seizures? How are they going to optimize neurological recovery? Are they mobilizing your sister? Are they getting her out of bed? Now that she’s got the tracheostomy, she should be able to be mobilized, assuming her brain pressures are fine, assuming there’s no other contraindications to get her mobilized, doing physical therapy, doing physiotherapy, getting her in the shower. All of that can be done. How are they supporting her body’s metabolism, especially if she’s on dialysis? Are they looking at electrolytes, potassium, magnesium? Are they doing that? Because there can be electrolyte imbalances when patients are on dialysis. If not, there’s still potential for improvement once those factors are addressed. Your sister has not been in ICU for a very long time.

What should you do next? Get access to all medical records. Get a full list of medications which is part of the medical records. Ask for the latest EEG, CT, MRI reports in writing. Again, that should all be part of the medical records. Clarify if your sister is still receiving any sedatives. Sometimes propofol, midazolam, fentanyl, morphine, dexmedetomidine can continue even in small amounts. I have seen that over and over again, that ICU teams tell families patient is completely off sedation and opiates and then we find the complete opposite. That’s why it’s so important for you to get access to the medical records so we can help you find that information. Request an independent neurological consult from the ICU and most importantly, reach out to us here at intensivecarehotline.com for one-on-one consultation, so we can review the medical records, review medications, EEG and all clinical data with you. I also talk to doctors and nurses directly, asking questions on your behalf, and you will see that the dynamics will change very quickly because we will help you to get the truth so that you can make informed decisions, have peace of mind, control, power and influence, so that your sister always gets best care and treatment so that she has the best chance to wake up and recover.

If you find this video helpful, subscribe to my YouTube channel click the like button, click the notification bell, share the video with your friends and family so you don’t miss any updates to what’s really happening in intensive care. If you want to discuss your situation in detail, go to intensivecarehotline.com and book your free initial call right now.

I have worked in critical care nursing for 25 years in 3 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, and you can verify that on our testimonial section at intensivecarehotline.com and 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 the 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, 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 e-books and 21 videos that I’ve 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 support at intensivecarehotline.com with your questions.

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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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