Hi, it’s 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, real power,
real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
How Do We Know If it’s Time to Do a Tracheostomy for our Critically Ill Mom in the ICU?
You can check out last week’s question by clicking on the link here.
In this episode of “YOUR QUESTIONS ANSWERED” I want to answer a question from one of my clients Tom as part of my 1:1 consulting and advocacy service! Tom’s mom is in ICU with a tracheostomy. Tom is asking if his mom is getting heavily sedated in the ICU.
How Do I Know If My Critically Ill Mom Is Getting Heavily Sedated in the ICU?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Tom here.”
Part 1
Patrik: Intensive Care Hotline, Patrik speaking. How can I help?
Tom: Hello, Patrik. Good afternoon, this is Tom. I’m calling on behalf of my dad, Ronald.
Patrik: Yes. Hi, Tom. How are you?
Tom: Hey I’m doing okay. My dad is gonna join our call. He’s just up upstairs from the hospital room right now. So he should be joining us shortly, but I wanted to hop on with you and just be mindful of the time we set in case you go.
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Patrik: That’s okay. Did you see the email that I sent?
Tom: Yes, I did. Looked over before we came to the hospital. So yes, I saw your questions. We put together some things that we thought we might be able to help give more information about, which I saw that you responded. But, yes, I did see your point to discuss as well as the overall of evaluation of
everything.
Patrik: Yeah. So after we looked at, the information that you shared closer, we really think, your mom is heavily, heavily sedated. Now, what is not a hundred percent clear from
the information that you shared? It’s a little bit vague about whether, for example, to us, it looks like she might still be getting some Versed boluses. It looks like she might also get on top of the Dilaudid, she’s also getting some oxycodone boluses. So that from our end, it doesn’t say the frequency. But it looks like it’s there. And from that end, it
is concerning that, you know, and that sort of leaves her in that situation where we think as soon as they try to wake her up. Well, of course she’s getting agitated because she’s been in such a deep sleep, that yes she would potentially withdraw going through withdrawal from some of the medications.
Tom: Yes. Oh, Patrik apologize. Can I call you right back? My mom needs me in a moment.
Patrik: You certainly can.
Tom: Okay. It’ll just be in a minute.
Patrik: Hi, Ronald. How are you?
Tom: Hi there Patrik, I’m good. This is Tom.
Patrik: Hi.
Tom: My dad wants to stay with my mom because she’s really alert and awake right now. So he asked me to take the call.
Patrik: Sure.
Tom: And just fill him in after. So it’s just me right now, but I’m doing good today. How are you?
Patrik: I’m very well, thank you. That’s good, that’s good. And how is your mom?
Tom: I’m on my way to see her now. So he got to the hospital a little before me. But from what he’s told me, just within the last few minutes, is that she’s good and she’s alert and awake.
Patrik: That’s good.
Tom: But I spoke with her bedside nurse last night and they explained to me that she had a bit more bleeding after the tracheostomy. Well, I guess I shouldn’t say a bit more. They say that happens with some patients, so she did bleed quite a bit. So they ended up giving her blood yesterday early in the
morning.
Patrik: What do you mean a lot? They’ve given her a blood transfusion?
Tom: Is that what it’s considered when they give you someone else’s… I’m not even sure of the terminology. Yeah, they gave her someone else’s blood.
Patrik: Okay, they’ve given her a blood transfusion. Do you know what her hemoglobin is like?
Tom: I don’t right now.
Patrik: That’s all right.
Tom: But I know that we have access to her arterial blood gas, is it that one that would show or is it not written up?
Patrik: Yeah, it would. It should show in an arterial blood gas. I mean, it’s not the end of the world if you don’t have the number but it’s good to have a trend of it and keep an eye. Did they tell you where the bleed… obviously it’s coming from the tracheostomy site. Did they say anything else? Why she might bleed?
Tom: No, other than she was on blood thinners where she will be susceptible to that but they have stopped it before the procedure. But I plan to have more questions when I get there today. I didn’t go yesterday, a family member wanted to go as well. We’re allowed to visit but haven’t been able to go yesterday. But
I’m on my way there now, so I can definitely inquire. What else should I ask regarding the bleeding?
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Patrik: I would ask how much blood has she had. Has she had one unit of blood, has she had two units of blood? Definitely get some quantity.
Tom: Okay. How many units?
Patrik: Yeah, I mean, normally no more than two units to begin with. But it gives you an indication of how severe was the bleeding.
Tom: Okay. And my dad, are they supposed to get his consent to do a blood transfusion? Because we weren’t notified prior to them doing it, because of bleeder emergency, I think.
Patrik: Possibly not because it’s sort of considered an urgent life-saving measure.
Tom: Oh, a life-saving measure? Okay.
Patrik: Very much so. There are certainly things like a tracheostomy, that’s an invasive procedure, definitely you need to give consent for that. But for blood transfusion, generally speaking, my experience is not so much.
Tom: Got it, okay. I mean, and I talked about it and I know that… and some of the doctor’s felt that they’ve done a bronchoscopy under emergency conditions and they
didn’t call him. So I think that’s what I told him. I mean, that was a judgement call and I understand they can do it. But he was just like, “Well, I was just wondering why they didn’t call me about this.” And he would have consented, but he was just asking me, “Can you ask Patrik, what the common policy of that is?” Got it.
Patrik: Look, they would have been triggered, giving a blood transfusion, because her hemoglobin would have been at the point where their policies and procedures say yeah, we’ll give some blood. And by asking for consent, you may delay what is really needed urgently. But out of courtesy yeah, they definitely could
have done that out of courtesy.
Tom: Well yes, but that’s the main thing that was a concern to us, right, was how she’s been healing from the tracheostomy. I mean, otherwise they are bringing her down off sedation. I don’t have those numbers right now because I guess that haven’t arrived yet. And my dad, he gets a little overwhelmed asking them those details. So I usually ask when I’m there and I write it down.
Tom: So I don’t know how much she’s lowered. The last update I got was they took off the Propofol it doesn’t mean it’s out of the question. It’s not that useful right now, they’re not using it and she’s doing good with Precedex as her sedation and anxiety-relieving medication. And she has some fentanyl for
pain.
Tom: Then I have some questions about her charts that I tried to discuss with the nurse last night. But they seem to be a bit more technical about the doctor’s notations. So I try to go over those questions with the doctor when I get there. And I’m happy to share them with you, but-
Patrik: Sorry Tom.
Tom: So do you think that we should talk more about… oh, can you hear me?
Patrik: I can hear you. Just before you carry on there, I just have a couple more questions. So you said she’s off Propofol, she’s now on Precedex. And did you say she’s on Fentanyl still?
Tom: Yes.
Patrik: Right, how much fentanyl, do you know?
Tom: I’m not sure but I can find out when I get there.
Patrik: Yeah. And did you say something else? Did you say there was any other sedation or is that it?
Tom: Those are all the ones that I recall right now. But I recall that because I remember wanting to get off the Propofol and not be on those. So I do understand that she’s there, where she’s been and at much lowered dose at this point.
Patrik: Good. And you mentioned earlier, she is more awake.
Tom: Yes.
Patrik: Right, that’s good. That’s good, that’s really good.
Tom: Yes. Very good, thankfully. I know some people have trouble waking up after all this. Fortunately, she’s not in that category. Among other things she’s struggling with, waking up, she seems to be doing okay. I was really emotional on Monday seeing her, because that’s the first time I’ve seen her really
alert.
Tom: As I mentioned we only get our last visit at the end of the day and I’ve missed a couple of visits. My sister went one day and my aunt went the other day. And those days were not the best, she was awake and I was like, “I’ve haven’t seen her like that yet.”
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Tom: So it was very hard for me to look at her situation, seeing her on Monday awake, and they ended up putting a PEG
tube in her, the stomach feeding tube. So after our visit they sedated her again to do that, but she tolerated it well.
Patrik: So they did do the PEG tube after the tracheostomy or on the same day?
Tom: They did it the next day because that day is when the tracheostomy bleeds. And they were actually going to… but that was on Thursday. But because they had to halt the blood thinners, the doctor ended up making an exception to do a night time surgery, and they did it. And it’s all worked fine.
Patrik: Okay. And when did they do the tracheostomy, which day?
Tom: The tracheostomy, okay. So they did it on Saturday because they did the PEG tube on Sunday, which was the last time I was there.
Patrik: Right, okay. The reason I’m asking, I’m trying to find out how quickly that bleed happened. Was that immediately after surgery? Sometimes that can happen too, if they nick an artery, for example, or a vein. Could be a result of…
Tom: Oh, okay. I can ask for sure if that’s… or if there was… I mean, they would have to tell us if they did that, right?
Patrik: Oh well, not only would they have to tell you. I mean, you could also look at the report from the surgery.
Tom: Okay, got it. No, I didn’t see that notated regarding the tracheostomy surgery. But one of my questions that I had for the doctor about the tracheostomy surgery is that… I’m trying to look for it, one second. She wrote a note during the procedure and it said BA… well, I can send this to you later, I’m sure
this is not that helpful. But I have it written down and I’m looking at it right now. BAL during tracheostomy, likely colonization. So I had it written as a question to ask for clarification, what happened during the tracheostomy procedure, because that was noted under the tracheostomy.
Patrik: Right. Did you say BAL?
Tom: Yeah, I don’t know what that acronym meant.
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Patrik: Bronchoalveolar lavage, I think that they might have sent a sample. Hang on, just give me a second. Bronchoalveolar lavage, yeah, they did. It’s a lavage, they did send a sample of the sputum, that’s what it is.
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Tom: Oh, okay. Like a culture.
Patrik: Yeah, culture. That’s right.
The 1:1 consulting session will continue in next week’s episode.
