My name is 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, 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.

Now, today I have an email from Stephen, and Stephen, first of all, I’m really sorry to hear about what happened to your father. Finding him collapsed at work, he’s had a cardiac arrest, he’s in an induced coma, and now he’s dealing with alcohol withdrawal on top of everything. This is an incredibly difficult situation for you and your family.

So, your dad experienced a cardiac arrest, which means his heart stopped pumping blood effectively. The medical team put him in an induced coma for 2 days to protect his brain and give his body time to stabilize. The fact that he’s now breathing on his own with a breathing tube and is able to move his eyes and squeeze your hands are actually very positive signs.

The challenge you’re facing right now is that he’s going through alcohol withdrawal while recovering from cardiac arrest. This combination makes his ICU treatment more complex, and I can hear how worried you are about the doctors suggesting withdrawal of treatment.

When someone who drinks heavily suddenly stops, especially in the ICU setting, they can develop alcohol withdrawal symptoms. These can include tremors and agitation, increased heart rate and blood pressure, confusion and delirium. In severe cases, seizures and delirium tremors.

The standard treatment approach includes:

Benzodiazepines: these are first line treatment for alcohol withdrawal. Common medications include lorazepam, also known as Ativan, diazepam or Valium, or midazolam, also known as Versed. These help calm the nervous system and prevent seizures.

Symptom triggered protocols: In ICU your father should be assessed regularly using tools like the Clinical Institute Withdrawal Assessment for Alcohol Scale and medications adjusted based on his symptoms.

Thiamine (Vitamin B1): This is critical to prevent Wernicke-Korsakoff syndrome, a serious brain condition that can occur in people with chronic alcohol use.

Fluid and electrolyte management: Maintaining proper hydration and correcting imbalances in potassium, magnesium and phosphate, multivitamins and folate to address nutritional deficiencies common in chronic alcohol use.

Supportive care: Including proper nutrition, either through the breathing tube or IV nutrition if needed.

Treatment options after cardiac arrest include:

Therapeutic hypothermia: Targeted Temperature Management – this may have been part of the induced coma protocol to protect his brain.

Cardiovascular support: Medications to support blood pressure and heart function if needed.

Neuroprognostication: MRI and assessments of motor skills and eye movements are helping the team understand how his brain was affected by the lack of oxygen, the critical issue, time and assessment.

And Stephen, here’s what concerns me about your dad’s situation. It’s only been a few days, and the medical team is already talking about pulling the plug and suggesting your father is not in a good state. This seems very premature.

After cardiac arrest with a brain injury, it typically takes at least 72 hours and often 5 to 7 days or longer to make accurate predictions about recovery. Especially when someone is also dealing with alcohol withdrawal and sedation from medications. The brain swelling you mentioned from the MRI needs time to improve.

The fact that your father can breathe on his own, even with a breathing tube, open his eyes, move his eyes, squeeze your hand, respond to you in some way, these are all meaningful signs that should give reason for continued treatment and time, not withdrawal of treatment.

Your next steps now are:

To get access to all medical records. You need complete access to all ICU notes and assessments, which include doctors’ notes, nurses’ notes, physio. Leave no stone unturned, it also includes MRI and brain imaging reports, EEG results if any were done, medication records, vital sign trends, ventilation charts, blood test results, the cardiac arrest report from when it happened. Having all the medical records allows for a proper independent review of your father’s case. He also would have had an ultrasound of the heart, and you certainly want that report as well.

This is exactly why I created intensivecarehotline.com. A consulting call with myself or my team will give you the expert advice you will need in this situation. Together with the ICU team, we will get on a consulting call with you, clarify the medical situation, question the premature talk of withdrawal of treatment, advocate for appropriate treatment duration, and for best care and evidence-based care and treatment, ensure your father gets optimal management for both cardiac arrest, recovery and alcohol withdrawal, challenge any bias the team might have about his prognosis.

We can review all the medical records, speak with the ICU team, and make sure your father gets best care and treatment and every chance at recovery. Sometimes families in intensive care need an independent ICU expert to advocate when the hospital team is moving too fast and too quickly towards withdrawal of treatment.

Also, explore long-term options. If your father needs prolonged ventilation support, whether invasive with a tracheostomy or non-invasive with a mask such as BiPAP (bilevel positive airway pressure) or CPAP (continuous positive airway pressure),  or if he needs a tracheostomy because he can’t be weaned off the ventilator, or he needs a tracheostomy because he can’t swallow, can’t clear his airway, you should know about Intensive Care at Home, and you can get more information at intensivecareathome.com.

This service provides long-term ventilation care at home with 24/7 intensive care nurses, which can keep your father out of ICU predictably and permanently, provide better quality of life than prolonged hospital stays and provide a much better quality of life than prolonged ICU stays, gives him a better chance at continued recovery in a home environment, offer both invasive and non-invasive ventilation support and/or tracheostomy support, provide palliative care options if needed. Many patients who are told they never get better in ICU actually continue improving at home once they’re out of the ICU environment with proper intensive care at home nursing support.

So, what to do next?

Number 1, request a family meeting with the ICU team and insist they give your father more time. It’s way too early for end-of-life discussions, and when you request a family meeting, have me to be present there so that I can advocate for your father.

Ask specific questions – what is the specific evidence that his brain is damaged?

What are they accounting for the effects of ongoing sedation, alcohol withdrawal, what is the plan for managing his alcohol withdrawal? Have they done an EEG/electroencephalograph to assess brain activity? Have they done a CT MRI scan of the brain?

What improvements have they seen since his admission?

Number 2, contact us at intensive care hotline.com immediately either email or call us on one of the numbers on the top of our website. We can review the medical records, have a consulting call with you and the ICU team, provide expert advocacy and consulting, and give you a second opinion on prognosis, treatment, and diagnosis.

Document everything in the meantime, write down what doctors, nurses say, when they say it, and who said it. And you need a patient advocate right now. You asked about exercises to help with his brain swelling. At this stage, the main treatment for brain swelling is time, proper positioning, head-of-bed elevated, avoiding fever, maintaining normal blood pressure, adequate oxygenation.

For communication and stimulation, keep talking to him. Tell him what the day, what day it is, where he is, remind him he’s in hospital but getting better, play familiar music, have family members talk to him, touch his hand, stroke his arm, read to him, talk to him.

And Stephen, recovery from cardiac arrest with brain injury combined with alcohol withdrawal is serious, and the road ahead may be long. However, it’s far too early to give up. Your father is only in his 50s, he was previously strong at working, and he’s showing some responses.

Many families I’ve worked with have been told their loved ones wouldn’t survive or would never recover, only to see significant improvement when given time and proper treatment. Don’t wait. Every day, every hour matters when an ICU team is talking about withdrawal of treatment. Get the medical records. Contact me at intensivecarehotline.com for expert advice, advocacy, and consulting, and to help you fight for your father to get the time and treatment he needs and deserves.

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.

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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.