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Quick Tip for Families in Intensive Care: My Mom Had Gall Stones Removed, Aspiration Pneumonia & Dialysis, Does She Need a Tracheostomy?

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care. So this morning, I was talking to a client who has their 62-year-old mother in ICU in a very complex situation.

Today, I want to break this situation down in case you are in a similar situation and you’ll know what to look for if you are in a similar complicated situation. I mean, any situation I see is really very complex and 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.

So let’s look at this situation with a client who has their 62-year-old mother in ICU, she had a cholecystectomy about two weeks ago, which is a gallbladder removal which came out of nowhere previously fit and healthy. She then even went home. It was just a day-stay operation, day-stay surgery, went home the very same day but was in a lot of pain. Got readmitted to the hospital within the next 48 hours, predominantly for pain management. And then she ended up with an aspiration pneumonia. She ended up intubated on a ventilator in an induced coma. She ended up with kidney failure and she was severely dehydrated because she couldn’t eat or drink in those two days when she got discharged after the cholecystectomy and the gallbladder removal.

Then to make matters worse, she ended up with an Ileus, which is a bowel obstruction, because a cholecystectomy can cause irritation of the bowels and can cause bowel obstruction. And also she was taking lots of opiates. And one of the side effects of opiates is, besides respiratory depression, is also that the digestive tract is slowing down, gut motility is slowing down and that can lead to an ileus too.

So then next, her hemoglobin dropped, and they didn’t really know why the hemoglobin dropped. So now she’s having units of blood, and she’s still sedated, she’s still on fentanyl, and now they’re wanting to do a tracheostomy after day nine. And I said to the client, well, it might be a little bit too early, and things like that need to be very carefully considered before you’re rushing towards the tracheostomy.

Have they tried to get her to wake up, have they tried to wean her off the ventilator? And the family again, has no idea. They haven’t asked the right questions yet. And they need a second opinion here so that (A) they can ensure the intensive care team is doing all the right things. They’re not doing a tracheostomy prematurely because the goal for an intensive care patient on a ventilator with a breathing tube, sedation and opiates is clearly to avoid the tracheostomy.

Also what the family didn’t know, given that she had aspiration pneumonia and cholecystectomy, is she septic? There’s a high chance this lady is septic. Is she on antibiotics? And the family had no idea what else is going on. Is she in septic shock for example? Is she on vasopressors or inotropes? Are her electrolytes in imbalance because if she’s losing red blood cells, if your hemoglobin is dropping down, if she’s on dialysis, her electrolytes such as potassium and magnesium might not be imbalanced.

The family really has no idea what else is happening. It is so important in a situation like that to understand. What are blood results? What does the chest X-ray show? What does the abdominal CT (Computed Tomography) scan show in a situation like that especially with ileus, with cholecystectomy? What’s her nutritional status? Is she well nourished? Is she getting the calories and the proteins that she needs in a situation like that? Does she potentially need to be nil by mouth? Because of the cholecystectomy because of the Ileus, does she potentially need TPN (Total Parenteral Nutrition), which is also known as IV or intravenous nutrition?

Once again, 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 in situations like that. Because if she’s not improving the next sort of spiel that the intensive care team might give to the family is, “Oh, she’s going to die.” It’s all negative. It’s doom and gloom. And what the client needs here is, education, a second opinion, and a look at the possibilities and the positives and not the negatives, but you need to know what to look for.  It’s like piecing together a puzzle.

When we give a second opinion, we look at blood results, we look at medications and again, we look at the diagnostics, chest x-rays, and CT scans. We look at the whole picture. We have a series of questions to go through with the doctors, and those questions are publicly available on our website anyway, but it’s also when depending on the answer you get from a doctor, then you need to have the next question ready. And that’s where you need the clinical insights.

So that is my quick tip for today.

If you have a loved one in intensive care in a similar situation, we have a membership for families of critically ill patients in intensive care and you can get access to the membership when you go to intensivecarehotline.com by clicking on the membership link or by going 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.

I also offer one on one consulting and advocacy for families in intensive care over the phone, Zoom Skype, WhatsApp, and whichever medium works best for you. And I talk to doctors and nurses directly. I talk to you and your families directly. Of course, I ask all the questions to the doctors and nurses that you haven’t even considered asking but must be asked when you have a loved one in intensive care so that you can make informed decisions, and have peace of mind, control, power and influence.

Now, I have worked in intensive care and critical care for over 20 years in three different countries where I worked as a nurse unit manager for over five years as well. I’ve been consulting and advocating for families in intensive care for over 20 years. And you can look up our testimonials and our client interviews on our website on the testimonial section and on the podcast section. It is without exaggeration for me saying we have saved many lives as part of our consulting and advocacy and we can do the same for your loved one in intensive care.

I also represent you in family meetings with intensive care teams so that you don’t get walked all over so that you have a strategy when you’re going into family meetings. And we also assess with you whether you should even go into a family meeting. Again, most families in intensive care have no idea that there are strategies that can be applied where you get the best care and treatment for your loved one and where you can negotiate better outcomes with intensive care teams.

We also offer medical record reviews in real-time so that you can get a second opinion in real-time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure or if you are simply 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 send us an email to [email protected]. 

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. Comment below what you want to see next, and what questions and insights you have. Share the video with your friends and families.

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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