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Quick Tip for Families in Intensive Care: My Mother’s Day 12 After Open Heart Surgery and Not Waking Up, Is This Normal?

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

So today, I have an email from Annette who says,

“Hi Patrik,

My mom has had open heart surgery. She also had surgery to remove several clots the following day. The day after that, repaired an artery. My mom has never had any kind of surgeries, no illnesses before ever, she has been very healthy. She exercises and she eats right, so it was a complete surprise. The surgery was 12 days ago and she’s non-responsive and has been removed from sedative drugs. I’m very concerned, she hasn’t woken up. She’s 75 and very healthy. Is this normal? From, Annette.” Well, Annette, thank you so much for sending that email.

So, after open heart surgery, it really depends or some of it depends on whether it’s elective or non-elective. So, you haven’t shared whether that was a planned surgery or that was emergency surgery because if it’s sort of planned, patients start off in a better condition, generally speaking, as if it was emergency situation. If it was an emergency situation, they had to rush your mom to surgery.

Then, you’re also not saying why she had open heart surgery. Did she have a valve repair, valve replacement? Did she have coronary artery bypass grafts because she had a heart attack, for example? Again, that would be important to make a distinction there.

Once again,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.

Then you are saying, she had several clots the following day. So, what that means is she probably had a cardiac tamponade, clots forming around the heart, putting her at risk of sustaining a cardiac arrest. So, they had to do that, but that also means she had to go under general anesthetics twice within 48 hours or within less than 48 hours. So, that again, makes it more likely for complications to occur.

What often also happens after cardiac surgery is that patients go into AF or Atrial Fibrillation or Afib, making the situation often more complicated, and they might end up on inotropes or vasopressors to sustain a blood pressure that is compatible with life really, and also that the organs are perfused. So, that is what often happens after situations like that. Your mom might have needed some blood transfusions because if she had clots, that also means she had some bleeding, probably leading to the cardiac tamponade. So, numerous things have happened. They just simply haven’t explained that to you.

Other things that would have happened, she would have had blood transfusions, and she probably had inotropes, vasopressors, and potentially vasodilators, to get the blood pressure down because it often fluctuates going up, going down.

If she has had an irregular heart rhythm, she would have ended up with medications such as amiodarone, potentially Digoxin. She would have had potassium magnesium replacement. She might have even had a cardioversion, or she might have needed a temporary pacemaker. Many, many things might have happened that you’re not even aware of in a situation like that where the intensive care team might have decided, “We better leave your mom in an induced coma and let her rest and heal.”

Now, 12 days is a long time. It should have only been a few more days, but for example, what might have happened in the meantime as well, did she have an infection? Did she have sepsis? Because she had surgery twice within sort of less than 48 hours that puts her at higher risk of an infection, puts her at higher risk of sustaining a Ventilator-Associated Pneumonia, also known as VAP. What else is happening that you don’t know at the moment, and what else is it that you haven’t shared because you don’t know what you don’t know.

Now, in terms of her not waking up, the first thing that they need to do is potentially looking at how many sedatives did she have? Did she have a lot of Propofol or a lot of Midazolam/Versed, lots of Morphine, and Fentanyl? Is she potentially simply overloaded from that? Is she in kidney failure? Is she not getting rid of the benzodiazepines, the sedatives, the opiates? Is that why she’s not waking up? Is she potentially in kidney failure or liver failure? Is she not getting rid of all of those sedatives and opiates?

Furthermore, if she is in kidney failure, has she been started on hemodialysis or hemofiltration? That would potentially help with getting rid of sedatives and opiates, and that might help her to wake up.

Moreover, have they done a CT (Computed Tomography) scan or an MRI (Magnetic Resonance Imaging) scan of the brain to rule out a neurological event such as a stroke, but have they done that? Have they done an EEG (Electroencephalography) of the brain? So, you’re saying she’s been removed from sedatives, how many days has she been removed for? Is she potentially still on opiates such as morphine or fentanyl or endone or any opiate, really?

Does she still have her chest drains in? If the chest drains are still in after cardiac surgery, they could cause pain, and she might need some opiates that might keep her asleep. So, I hope that gives you some insight of what needs to happen next. Make sure they’ve definitely removed all sedatives and opiates, maybe they need to give an antidote for morphine or fentanyl, such as Naloxone to help her wake up.

More importantly, they need to rule out has she had a stroke? That’s what they need to do. Do a CT scan or an MRI scan of the brain, and potentially do an EEG. The question also is what it means she’s not responding? Is she responding a little bit? Is she opening her eyes? Is she doing nothing at all? You got to assess that as well. What do you mean by when you’re saying she’s not waking up? Is she at least opening her eyes? Can she squeeze your hands, for example, if you ask her to? Those are the sort of signs you should be looking for.

Now, that’s my quick tip for today.

We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com when you click on the membership link, or you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in a membership area and via email, and we answer all questions, intensive care related.

I also 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, and I help you understand how to navigate the difficult landscape that is intensive care. But more importantly, I help you to make informed decisions and have peace of mind, control, power, and influence.

I’ll make sure you get results. Results are the name of the game. 99% of families in intensive care don’t get results. They don’t get the best care and treatment for their loved ones in intensive care because 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, and that’s exactly where I help you with.

I also talk to doctors and nurses directly and I ask all the questions you haven’t even considered asking but must be asked. So that, once again, you make informed decisions, and have peace of mind, control, power, and influence.

I have worked in critical care for over 20 years in three different countries where I also worked as a nurse unit manager for over 5 years. I have been consulting and advocating for families in intensive care all over the world here at the intensivecarehotline.com since 2013.

I encourage you to look at our testimonial section where you can see what our clients say. I also encourage you to look at our podcast section for some client interviews to see what they say. I can confidently say that we have saved lives with our consulting advocacy by advocating for families in intensive care.

Like I said, getting results for our clients that they thought previously was not possible because we’re giving them all the tools, the insights, the strategies to advocate and making sure you get a crash course in intensive care that will help you to look for the right things and ask the right questions and more importantly, also educate you on your rights.

Now, 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 in case you have unanswered questions, you need closure, or if you are simply suspecting medical negligence.

I also represent you in family meetings with intensive care teams so that you don’t go in family meetings without any clinical representation and without any consulting and advocacy in those meetings because otherwise, you might get walked all over.

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].

Now, 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, what questions and insights you have, and 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.