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Quick Tip for Families in ICU: My 74-Year-Old Dad’s in ICU After Subdural Hematoma & Not Waking Up After Two Weeks in Induced Coma!

If you want to know if your loved one is critically ill in intensive care after a subdural hematoma and is not waking up, stay tuned. I have news for you.

My name is Patrik Hutzel from intensivecarehotline.com, and I have another quick tip for families in intensive care.

Today, I have an email from a reader who says:

“Hi Patrik,

Thank you for your YouTube channel and for all your great videos.

My 74-year-old dad has been in ICU for a little over 2 weeks, originally presenting with a subdural hematoma after a fall. He had a successful micro-drilling procedure, which is also known as a burr hole, but he suffered stubborn seizures, and they threw every medication they could at him. It’s been about 5 days since he’s been off phenobarbital, fentanyl, and a few others, as well as lowering the seizure medications, without any new seizures presenting.

We haven’t been successful in getting him to wake up yet, and he’s still on the ventilator, although he overbreathes on it on minimal settings because his heart, kidney, lungs, and liver are very healthy. They tried a ketogenic diet, but he couldn’t produce ketones. I did mention the possibility of Ambien counteracting to try and take him out of the coma. Any other suggestions would be super appreciated.”

First off, two weeks in ICU after a significant subdural hematoma and brain surgery, and only been five days off phenobarbital and fentanyl, is probably not a long time. I understand that for you, it must feel like an eternity. For you, this is like living your worst nightmare. But in the bigger scheme of things, I think, given that his organs are fine and given that he’s already breathing over the ventilator, that’s a sign that something is there, and that’s a sign that your dad is slowly making progress.

Some of it depends, of course, what the CT (Computed Tomography) of the brain, and the MRI (Magnetic Resonance Imaging) scans of his brain show after the surgery. You should absolutely talk to the neurosurgeon and also neurologists in terms of what they are expecting. Also, because he’s been on phenobarbital, that is one of the strongest sedatives when it comes to neurological conditions in particular. It’s sort of the last sedative you use when someone can’t be properly sedated, i.e., is having seizures, so you absolutely have to give it some time for him to wake up.

What is also important here is that he is getting stimulated slowly, like with physical therapy, and movement therapy. Does he need a tracheostomy? You’re saying he’s been ventilated for about 2 weeks. So, the question here is also, does he need a tracheostomy if he can’t come off the ventilator yet?

Ideally, he won’t need a tracheostomy, and he can just be extubated. But if he’s over 2 weeks of being ventilated with a breathing tube, and he’s not ready to come off the ventilator because he had to be sedated for so long, then you absolutely need to start thinking about it, and the ICU team needs to absolutely think about a tracheostomy here. It’s easier for him to tolerate mechanical ventilation. It’s also often easier to come off the ventilator once patients have a tracheostomy. That might sound counterintuitive if you haven’t done any research about a tracheostomy, what it does, but it most likely will help to get him off the ventilator. It’s much easier to tolerate, and it’s much easier to take someone on and off the ventilator while they’re getting ready to be weaned off the ventilator.

In terms of the diet, I cannot comment on that. I’m not a dietitian, but you should absolutely talk to the dietitian in the ICU and see what they think might be best to help your dad in the recovery process and see what they suggest.

Also, have a look at what anti-seizure medications he’s on. If he’s still seizing, he will need them, but keep in mind that anti-seizure medications such as Keppra, phenytoin, Vimpat, they all have some sedative effect, so that might also contribute to your dad not waking up yet. So please keep all of that in mind.

I know it’s cliché what I’m saying now, but you might need to be patient, and you might need to look for the baby steps that will lead your dad to a road of improvement. It might be a slow and gradual improvement. You might also find that your dad may not have the quality of life that he had before, but still, his life might still be worth living. That is something that you will find out over time. I’m glad you haven’t mentioned anything about the ICU team wanting to push your dad towards the end of life. So that means maybe they have a good prognosis for him too, if he keeps improving. I hope that helps.

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

Overall, I have looked after thousands of critically ill patients and their families, either when I worked in ICU as a nurse or here at intensivecarehotline.com. So, I have an in-depth understanding of intensive care. We have helped hundreds and hundreds of members over the years here at intensivecarehotline.com.

That’s why we have created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com by clicking 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 videos and 21 eBooks that I have personally written and recorded. All of those resources will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

I also do one-on-one consulting and advocacy over the phone, Zoom, Skype, 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 can’t afford to get wrong. I also talk to doctors and nurses directly. I ask 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 you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

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 regular updates for families in intensive care. Click the like button, click the notification bell, 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 a show. You will get notification for the YouTube live if you are a subscriber to my intensivecarehotline.com email newsletter.

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.

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