“The ICU team playing games with my mom’s pain medication and blood pressure—What families in intensive care must know.”

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, making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

So today, I have an email from one of our clients who says:

“Hi Patrik,

I’ve just gotten back from ICU, and I have a private aide there now. They increased my mom’s midodrine to 30 mg every 8 hours and added in Florinef. I was very excited about droxidopa (Northera); however, it can’t be given through the PEG tube (Percutaneous Endoscopic Gastrostomy) supposedly. I spoke with the nurse as well and said I’m open to a second vasopressor.

My mom and I have to come home with Intensive Care at Home and respiratory therapist. The hospital wants us to have, our excellent private aides, and our durable medical equipment. What bothers me is that the ICU is playing a game of pressors or PRN pain meds. When my mom gets wound care for the stage 4 pressure sores, they’ve caused her, she’s supposed to get an IV push of 12.5 mcg fentanyl.

They try to say that the blood pressure is too low. However, I point out that it skyrockets during wound care because of the pain. I don’t leave the room. They’ve asked, but as proxy, it’s my right to stay. So, my mom gets the pain medications, but not always on time.

Their argument is that we must either choose “comfort care” or regular care (no pain meds). Something seems illegal about that. Anyway, they can’t force people to choose euthanasia. My mom should get the best care, period. We’re probably the best customers in that hospital. I hope to talk more about this tomorrow on our call.”

So, this is an excellent and also very important question. Unfortunately, it’s a scenario I hear way too often in ICUs around the world.

So, here’s the truth.

Your mom is absolutely entitled to adequate pain relief, regardless of her blood pressure. ICU teams must titrate and manage medications safely, not withhold them altogether, saying you must choose between “comfort care” and “regular care” is completely misleading and unethical. It’s also a case if the ICU caused the pressure sores and the wounds. That’s another massive concern because a pressure wound, it’s really a never event.

Also, pain management is part of basic medical care, not comfort care or even end of life care. The ICU has a duty to balance hemodynamic stability, blood pressure with comfort and dignity. They can and should use vasopressors, fluids, or midodrine, Florinef, to support blood pressure while giving pain relief. To deny pain medication because of low blood pressure, especially when pain itself can cause spikes in blood pressure and heart rate is poor clinical practice, generally speaking. Pain increases stress hormones like catecholamines which can actually worsen instability.

Let’s be clear, no one should ever be pressured into comfort care or euthanasia, which, by the way, is illegal, just because the ICU finds it more convenient. That is not their decision, it is your decision as the medical power of attorney or next of kin. The ICU team’s role is to treat and support your mom, number one, medically and ethically, not to rush in care or emotionally manipulate families into withdrawing treatment and letting their loved ones die.

You’re absolutely right to stay in the room during wound care as a proxy and medical power of attorney; that is your legal and ethical right, assuming your mom wants that.

I’ve seen far too many situations where pain management or sedation is delayed or skipped when families are not present. Your approach, having private aides, a respiratory therapist and preparing for home care may not be the right one because you will need 24/7 intensive care nurses at home which is evidence based.

Your mom going home from ICU with a tracheostomy and a ventilator, especially on midodrine, will need more than aides, and that is actually evidence-based when you look on our website at intensivecareathome.com. When you look at the Mechanical Home Ventilation Guidelines, it is evidenced that exclusively critical care nurses with a minimum of 2 years critical care nursing experience are safe to look after ventilated and tracheostomy patients at home, including giving midodrine, which is a vasopressor and an inotrope, which cannot be managed by aides. It would be unsafe, and it could cause medical emergencies or even death. You cannot compromise comfort or dignity whilst building a safe transition home with Intensive Care at Home and 24/7 intensive care nurses.

So, to summarize, pain relief is a right, not optional. Comfort care does not mean no treatment. You can insist on both: pain management and life sustaining treatment. Document everything and escalate appropriately if they continue withholding medications. Get access to all medical records, I can’t stress this enough. Get access to all medical records and get a second opinion. Reach out to us at intensivecareathome.com so we can prepare and get ready for home care for your mom.

If you are in a situation like this and you don’t know how to handle ICU teams and potentially games around pressors, pain relief, or comfort care, potentially euthanasia discussions, even though no one in ICU will ever use the word euthanasia because they know it’s illegal, but at the end of the day, that is what’s unfortunately happening in many ICUs around the world.

So go to intensivecarehotline.com, call us on one of the numbers on the top of our website. We help you speak up, get clarity, get results, and ensure your loved one gets best care, and right care and treatment without being pressured into decisions that go against your wishes or values.

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 review 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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