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

Why is it Important for My Daughter to Be Weaned Off the Ventilator As Early As Possible in the ICU?

You can check out last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED”  I want to answer questions from one of my clients Romeo, as part of my 1:1 consulting and advocacy. Romeo’s daughter is with a breathing tube and on a ventilator in the ICU. Romeo is asking why it is necessary to have a medical record review for his daughter in the ICU.

My Daughter is Critically Ill in the ICU & Why a Medical Record Review is Necessary?

“You can also check out previous 1:1 consulting and advocacy sessions with me and Tess & Romeo here.”

Part 1

Part 2

Part 3

Part 4

Part 5

Part 6

Part 7

Part 8

Part 9 

Tess:  He’s asleep at the moment. I’ll get that and ask him that for you in the morning. I’ll give you a ring later on today.

Patrik:  Yeah, absolutely. But I think since we last spoke, there are definitely positives. She’s moving forward. Ask for the Glasgow Coma Scale.

Tess:  Okay. I might be able to get that until 5:00 tomorrow afternoon.

Patrik:  I doubt it. Let me ask you this. If you rang the nurse now and you ask them, “What’s her Glasgow Coma Scale?” Do you think you’ll get the nurse on the phone?

Tess:   Not necessarily, because they are the nurses milling around. 

RECOMMENDED: 

• Membership for families in Intensive Care
• Book your free consultation call here
• Check out our Ebooks and videos
• If you want a medical record review, please click on the link here  

Patrik:  Right. Even the nurse in charge should be able to answer that question for you. Just remind me, do you have access to the medical records online?

Tess:  No.

Patrik:  Okay. It would be there as well, in the medical records.

Tess: I don’t have access to any medical records related to Sarah.

Patrik: Have you requested that?

Tess:   I’ve asked for actual documentary, proof from the director. The lady doctor that we spoke to. I think it’s about 4 or 5 days ago. His eyes widened. He looked a bit stressed at that thought. What looked like, you know what I mean?

Patrik:  That doesn’t make any sense to me because that’s your right.

Tess:  Exactly. But they haven’t been forthcoming as off yet.

Patrik:   Have you formally requested access to the medical records?

Tess:  Would that been in writing?

Patrik: Yes, in writing, but it could be as simple as you saying to them, “Hey, look, I want access to the medical records,” either.

Tess:  I’ve already asked. Yes, we have.

Patrik: What was their response?

Tess:  As I said to you, that doctor said, “Yes,” but nothing’s been forthcoming. I haven’t seen him.

Rey:   Yes, Tess. He averted because we were also asking about a neurologist.

Tess:  Wait a minute.

Rey:  …to talk to us and he answered that part into a bit about the medical records.

Recommended: 

• My Dad in ICU has a Fighting Chance to Survive but the ICU Team Thinks Otherwise. Help!
• What’s my Dad’s life expectancy after he had a tracheostomy? Live stream!
• Should you go into a family meeting with the ICU team when you have a loved one in ICU? Live stream!

Tess: Okay. That’s more accurate. Yeah. Because I’ve been tied on occasion. I’m trying my best. It’s true that he didn’t really answer on that. All I recollect is his eyes widened. Like it was a big deal, do you know what I mean?

Patrik:  Yeah. It shouldn’t be a big deal because it’s your right. It’s not a privilege.

Tess: Okay. As next of kin, but I’ve not got power of attorney or anything like that.

Patrik:  Right. Have I sent you the link to the guidelines about access to medical records? Have I done that?

Tess:  Yes. You have. It says basically I haven’t got any remit.

Patrik: Right. Because you are not power of attorney?

Tess:  Yep.

Patrik:   Right. I would still keep asking. You are the next of kin. I would still keep asking.

Tess:   Okay. I’ll ask again tomorrow.

Patrik:  Yeah.

Tess:  That may or may not be before you actually get to speak to a nurse with me, hopefully. We’ll sort that out later on for in the day.

Patrik: Right, yeah. That would be good.

Tess: Okay. I don’t know. What else I can…

Rey:   Do you have any…

Tess:  Yeah. Do you have any further… I’m sorry.

Patrik:  No. How often do they suction her? Do you know?

Tess:  I don’t, but I’ve seen it happen. It looks unpleasant experience. Her whole face was grimacing.

Patrik: Right, sure. Is she coughing now?

Tess: Nope.

Patrik:  Right. Did you say there was at least the gag reflex now?

Tess:  Yes, there is. But that was confirmed at first by the neurologist. That she does have a gag reflex, but it’s weak.

Patrik:   Okay, I see.

Tess:  She’s not saying anything.

Patrik:  Right. Has she been sitting out of bed at all?

Tess: Nope.

Patrik: Do you think she could?

Tess:   She’s not getting out of bed at all, no. She’s just like prostrate.

Patrik:  Yeah, sure. But what I’m asking, do you think that she could get out of bed sitting in a recliner chair?

Tess:  Very difficult to say because she’s in a half upright position as it is propped up. I couldn’t even answer that. I’m not quite sure. Because if she’s not moving her hands…

Patrik:  Yeah. That’s okay. I argue yes, that she could sit in a recliner chair. I argue.

Tess: Okay. Wow. The fact that you say that is encouraging. What bearing does that have on things? Is that something that should be asked by me?

Patrik:  Yeah. Ask her. Can she sit in a recliner chair? Keep things simple. Keep things simple.

Tess: Yeah, in a recliner chair.

Patrik: You need to be very direct with them in terms of what you’re asking for. There’s no point in beating around the bush. Can she get mobilized? Can she get in that chair? And then see what they say.

Recommended:

• WHAT ARE THE BENEFITS OF EARLY MOBILIZATION OF MY LOVED ONE IN THE ICU?
• Should I get access to medical records for my Husband while he is in Intensive care? Live stream?
• The ICU team is negative about my Dad’s condition, but is there hope? Live stream!

Tess:  Mobilized. Okay.

Patrik:  If they say no, I argue they’re lazy.

Tess: Okay, interesting.

Patrik:  Not the only reason, but it’s one of the reasons to do a tracheostomy, to start mobilizing patients.

Tess:   The pertinent question would be, when are you going to start mobilizing her?

Patrik:  Yeah, very much so.

Tess: Okay. Thank you.

Patrik:  Picture this. She might be close of getting off the ventilator. I don’t know that without having looked at the ventilator or without knowing the ventilator settings.

Patrik:   If he can’t be weaned off the ventilator, she needs to start sitting up because that will strengthen her upper body and that will help her breathe.

Tess:  Yes. Needs to start sitting up. Sorry, I didn’t catch that first bit. Is that if she can’t get off the ventilator?

Patrik: Correct. If she can’t get off the ventilator, she needs to be mobilized one way or another.

Patrik: She needs to be mobilized one way or another.

Tess:   Even if that would cause her to stress and discomfort.

Patrik:   Not to that point, but reality is this, she might only be able to sit up for 5 minutes to begin with, but you got to start somewhere.

Tess:  Yes, okay.

Patrik:  But if it causes her discomfort after 5 minutes, stop, of course.

Tess: What if she were dizzy as a consequence of the combination of the anti-convulsant? That could have been, couldn’t it?

Patrik:  It will probably show up in her vital signs. God forbid, she may start vomiting or any of that. There are risks attached to that, of course. But the best analogy that I can give you with this is mobilization, ventilation, weaning is you can’t be running a marathon without training. It’s the same. You can’t be weaned off the ventilator without improving your physical capacity. 

Recommended links: 

• 10 things you need to know about tracheostomy in and outside of intensive care! Live stream!
• Mom’s been in ICU for 3 months, what are the long term consequences of mechanical ventilation?
• The ICU team is negative about my Dad’s condition, but is there hope? Live stream!

Tess: Yes. And 45 mls on the feed at the moment.

Patrik:  And what, 45?

Tess:  Mls on the feed.

Patrik:  Oh, I see. Sure. 45 mls an hour.

Tess:  Yeah. I don’t have… Yeah.

Patrik:  Other than that, kidneys are working. There’s no issues with the heart as far as you’re aware. Livers working.

Tess:  Yes. Nothing’s been mentioned about them.

Patrik:  Okay. Again, looking back to where we were last week, there’s definitely some progress.

Tess:   I’m glad to hear that. I believe so.

Patrik:  Do you feel that way?

Tess:  Sorry, I didn’t catch that.

Patrik:  I said, do you feel that way that there’s progress?

Tess:  There was definitely progress before the sodium valproate, with her eye contact with us a couple of days ago for sure.

Rey:  And yesterday.

Tess:  And yesterday, yep. But today wasn’t good. Could she have been in a half-asleep state today and still have his eyes slightly open with his eyes moving from side to side?

Patrik:  Yeah, for sure.

Tess:  Okay. I might have caught her at a time when she was asleep.

Patrik: Yeah. Have you familiarized yourself with the Glasgow Coma Score?

Tess:  Yes.

Patrik:   Right. Last week apparently was a 3. Just by her having eyes open is at least the 4. Now, that’s not a massive improvement, but there’s some improvement.

Tess:  May I pass you to Rey, please?

Patrik:  Sure.

Suggested links:

• YOUR QUESTIONS ANSWERED LIVE: HOW TO WEAN OFF VENTILATION AND TRACHEOSTOMY IN ICU?
• TRACHEOSTOMY AND WEANING OFF THE VENTILATOR IN INTENSIVE CARE, HOW LONG CAN IT TAKE?
• Why Would A Critically Ill Patient In An Induced Coma Need A Tracheostomy In Intensive Care?

Rey:    Hello again.

Patrik: Hi Rey.

Rey:  Just wanted to say, to do with the Glasgow Coma Scale, I think we had an update of that a few days ago. I think when Tess asked, she was in the corridor the same time when she said that she had a weak gag reflex. She also said that her Glasgow Coma Scale was 3.

Rey:   Now, with the whole thing about her eye opening and her making eye contact and her potentially, I don’t know whether Tess has mentioned this. But she has seemed to have a weak tracking movement with her eyes. Her eyes are getting drawn to sound from around her environment. Because she’s looking away, because I can hear on the Zoom call, I can hear the commotion around her. She’s being drawn away. Things like that. I would think they would surely increase her GCS (Glasgow Coma Scale) score. That she can’t surely be a 3 at this point with what I told you.

Patrik:   No, she can’t be a 3. No.

Rey:  That’s right. That’s what I thought. Yeah.

Patrik:    Is that what they’re telling you? That she’s a 3.

Rey:  I believe he said that… You’ve just muted yourself, I think Patrik. Yeah. You’re unmuted now.

Rey:  Yeah. I think I remember her saying to us that she was still a 3, which I thought was really bizarre because then on the Sunday, she began to open her eyes around end of the week, Sunday started paying attention more, started focusing more really. I must stress the fact that we had about a 2 1/2 hour Zoom call with her. Was it yesterday?

Tess:   Yeah.

Rey:  Pretty much apart from the sounds around her environment, she was focused on us. I could see her eyes were focused on the same place. They weren’t absentmindedly moving around in different directions. They were focused. She maintained a really good focus for an extended period of time. That was yesterday. I have no doubt in my mind that surely, Patrik, I really don’t think that she’s still a GCS of 3. I think there’s definitely some improvement.

RECOMMENDED: 

• 1:1 Email counselling and consulting with Patrik
• 7 days unlimited 1:1 phone consulting and advocacy
• Membership for families in Intensive Care
• 1:1 phone and email counselling and consulting with Patrik  

Patrik:  No, if she’s got her eyes open, she can’t be a GCS of 3.

Rey:   Yeah. Okay. That’s all I wanted to say. Thanks. Thank you.

Patrik:  Fair enough. Yeah.

Tess: Okay. I don’t know how time is doing for you. Obviously, we’ve spoken for a fair while, Patrik. I’m not sure what else I can really update you on.

Patrik:    No. I tell you. We need to talk to them. I also believe that you are having access to the medical records is important. Because we will get that on a call, but if you have access to the medical records in this day and age, it should just be online with a link to a website with the username and a password.

Tess:  Okay. Wow. I didn’t realize it was that easy.

Patrik:   Not every hospital has that. But in this day and age, that should be the goalpost really.

Tess:  Okay. So medical records access, right. Okay. I’ll do my best. As I said, I’ll speak to you later on. For you, what time would be good, do you think?

Patrik:    Look, what time do you think is best in terms of who’s there? Tell me your ideal time then I will tell you whether I can do it or not.

Tess:  Yeah. Let’s say 10:00 in the morning.

Patrik:   Yeah, that’ll be fine.

Tess:  Okay, lovely. Thank you very much, indeed. Wishing you a good day and speak to you later.

Patrik:   Okay. Thank you so much. Have a good night. Thank you so much. Bye.

Tess:   Thank you, Patrik. We appreciate your help. Thank you.

Patrik:   It’s a pleasure. Thank you so much. Thank you. Bye-bye.

Tess:  Bye.

• Email counselling/consulting with Patrik
   
• One on One phone/ Skype counselling/consulting with Patrik