Quick Tip for Families in Intensive Care: My Mother isn’t Waking Up After 8 Days in ICU After Cardiac Arrest and Anoxic Brain Injury! Help!

Hi, it’s Patrik Hazel from intensivecarehotline.com with another quick tip for families in intensive care.

Today, I have an email from Rebecca who says,

“Hi Patrik,

My name is Rebecca. My mom had a cardiac arrest 8 days ago. She was PEA.” PEA stands for Pulseless Electrical Activity. What that means is that a patient shows on an ECG rhythm strip that there’s actually a pulse. But as a matter of fact, it is not a pulse. So, the heart isn’t beating. It’s just electrical activity that’s not transferring to a cardiac output.

“She was down for 28 minutes. Emergency medics were present when she went pulseless. The EEG (Electroencephalography) says she had an anoxic event and neuron firing is slowing. The MRI (Magnetic Resonance Imaging) shows nothing good or bad. When propofol was held to check if she can follow commands, she calmed at this time. She moves her head side to side, not constantly or rhythmic. She feels pain, frowns her face. How long do we give to check brain injury? This ICU says a few more days. She’s also on a ventilator. Thank you and God bless from Rebecca.”

Thank you, Rebecca, for sharing your mom’s situation and I’m very sorry to hear what has happened here.

So, let’s break this down. First off, 8 days in ICU is not a very long time. It is not a long time, and you need to be patient here. If Propofol was stopped and she didn’t wake up, it sounds to me like propofol was restarted.

You are saying, “Propofol was held to check if she can follow commands, she can’t at this time.” Is propofol back on? If yes, why? It should be off, opiates should be off. Did they do cooling therapy in the beginning for 24 to 48 hours?

If the MRI shows nothing, what makes them so certain there is an anoxic event? I understand that the EEG says that, but you need verification for that with an MRI scan or a CT (Computed Tomography) scan of the brain.

So, she’s definitely moving something. She’s moving head side to side, not constantly arrhythmic, but she’s moving. She feels pain, frowns her face. So, there’s definitely some brain activity there.

Now, the other question that you always need to ask in a situation like that, is she at risk of seizures? Is she having seizures? If she’s having seizures or she is at risk of seizures, they’re probably also giving her anti-seizure medications such as phenytoin or Keppra, and they also have sedative effects.

Next, she may not wake up because simply she’s too sick. Some patients in intensive care, often an induced coma, it can take them days to wake up even without a brain injury. So, it may just simply be delayed because she is very sick and she just needs time, but you won’t know until you give her that time. Like I said, I can’t stress enough that eight days in ICU is not a long time.

Also, if she isn’t waking up, she may need a tracheostomy. It’s Day 10 to day 14 of mechanical ventilation with a breathing tube and the inability to wean off the ventilator that a tracheostomy might be needed.

Next, is she in kidney or in liver failure? Because if she is, that may also delay her waking up, it may delay waking up because sedatives and opiates are still in the body, they can’t be metabolized. It can’t be excreted through the kidneys. So, that can also delay waking up.

Is your mom potentially overweight? Because there’s a higher chance that for overweight people, that sedatives stay in the body for longer because it’s stays in the fatty tissues, also something to consider. So, I would give this a few more days.

Also, what they should be doing if she’s not at risk of seizures, we should be starting to do physical therapy, mobilization  as quickly as possible. If her vital signs are stable, of course, if she is hemodynamically stable. So, don’t be discouraged here. There is definitely something here.

It is way too early to see where this is going. I would really like you to check in a few more days and see how you go with your mom in this situation. Don’t give up because you know where giving up leads to.

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.

As a matter of fact, most families in intensive care, they don’t even know that, you managing doctors and nurses is a real strategy and gives you the outcomes that you need, you want, and you deserve.

Because we are finding that so many families in intensive care are struggling, that’s why we have created a membership for families of critically ill patients in intensive care at intensivecarehotline.com. Click on the membership link and you can get access there or you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, via email and in a membership area, and we answer all questions, intensive care related.  In the membership, you also have access to 21 e-books and 21 videos that are specifically written/recorded for you and your family that help you with many proven strategies.

I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years, that’s also why I offer one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly, I talk to doctors and nurses directly, and I change the dynamics in your favor.

Once again, I have worked in intensive care for nearly 25 years in three different countries where I have also worked as a nurse manager. I’ve been consulting and advocating for families in intensive care all around the world since 2013. I can say without any hint of exaggeration that we have saved countless lives here with our consulting advocacy. You can verify that on our testimonial section or on our podcast section with some client interviews.

Now, when I talk to doctors and nurses and I talk to you, I ask all the questions that you haven’t even considered asking, but must be asked when you have a loved one in this once in a lifetime situation that you can’t afford to get wrong, and that helps you to make informed decisions, have peace of mind, control, power, and influence.

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. You can call us on one of the numbers on the top of our website or send us an email to [email protected]. I also represent you in family meetings with intensive care teams and I’ll make sure once again your loved one gets best care and treatment.

Now, if you like my videos, subscribe to my YouTube channel for families of critically ill patients 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 and what questions and insights you have from this video.

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.