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

Archie Battersbee Fight for Life After Parents Lose Legal Battle Over Life Support! What Happened?

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 is it important to ask the right questions to the ICU team.

What are the Right Questions to Ask When Talking to My Daughter’s Doctors & Nurses in the ICU?

“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 

Part 10

Part 11

Tess:  Hi Patrik.

Patrik:   Hi Tess, are you ready now for the call?

Patrik:   Do you want me to dial them in?

Tess:  I can give you the number.

Patrik:  Yeah.

Tess:  Do you want to do it?

Patrik:  Yeah. I’ll do it.

Tess:    Okay. I’ll text you the number, Patrik.

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Patrik:   Got it. And who will we get on the call when we call that number?

Tess:   I’m assuming one of the nurses who’s going to call.

Patrik: Okay.

Tess:  It could be a doctor.

Patrik:  Yeah.

Tess:   It could be one of the nurses.

Patrik:  Ok

Tess:   It’s not an actual room, it’s a separate room from her.

Patrik: Oh, I see.

Tess:   That’s the set up.

Patrik:   Yeah, okay.

Tess:   In a large room.

Patrik:   Right.

Tess:   But the phone is within, literally, overlooking her. It’s in front of her, just a small distance.

Patrik:  Yeah.

Tess:  Away.

Patrik:  Okay. So, when they answer, you need to do the talking to begin with.

Tess:  Yes.

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• Quick tip for families in ICU: Why you need to talk to the medical specialists outside of ICU!

Patrik:   Just get to someone that can answer questions. And if for whatever reason the nurse is busy, I’m just trying to think, do you think… We could talk to the nurse in charge, but I do believe the..

Tess:   Would that be..

Patrik:   The bedside nurse.

Tess:  Do you think that would be a good idea?

Patrik:  I would prefer speaking to the bedside nurse.

Tess:   Yes.

Patrik:  A good bedside nurse has all the information. The nurse in charge has the bigger picture but doesn’t necessarily have the nitty gritty.

Tess:  Okay. So, what I should be doing is asking who’s looking after her currently, and would it be possible to please speak to them?

Patrik:   Correct and don’t mention anything about me. We can bring me into the picture once we talk to the nurse.

Tess:   Okay.

Patrik:  Alright, let me

Tess:   That’s fine.

Patrik:  So once someone answers, you need to do the talking.

Tess:  Okay.

Patrik:   Just bear with me.

Tess:  Thank you.

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• “PEACE OF MIND, CONTROL, POWER AND INFLUENCE EVEN IN THE MOST CHALLENGING OF CIRCUMSTANCES THAT YOU, YOUR FAMILY AND YOUR CRITICALLY ILL LOVED ONE COULD POSSIBLY FACE IN INTENSIVE CARE!”
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Hedda:   Hello, good morning.

Hedda:   Hello?

Tess:   Hello, is that the ward in which Sarah is admitted?

Tess:    She’s my daughter. My name’s Tess.

Hedda:   Sorry, say it again?

Tess:  Is Sarah on Bed 12?

Tess:   I’m Sarah’s mother.

Hedda:  Okay, hi. Good morning.

Tess:    Sorry good morning.

Hedda:   Good morning, are you coming to visit her?

Tess:  I will be there later on today, at 2 o’clock.

Hedda:    Okay.

Tess:   I want to..

Hedda: I’m the nurse that’s looking after her.

Tess:   You are the nurse looking after her? That’s wonderful. How’s she been?

Hedda:    Oh, in the morning, doctors came, and they wanted her to be in the tracheostomy mask for 5 hours at a stretch. And like that, two 5-hour trials, we need to be looking for today.

Tess:   Okay. I actually have a family friend, who’s on the call and he’s had considerable critical ICU nurse experience.

Hedda:  Okay.

Tess: His name’s Patrik.

Hedda:   Yes?

Tess:  Would you just have a little chat with him please, so that I can have a better understanding generally of what’s going on. Please, Patrik?

Patrik:  Hi, hello. How are you?

Hedda: Hi.

Hedda:  Hi, can you hear me?

Patrik:   I can hear you. Can you hear me?

Hedda:  Yeah. Hi, Patrik.

Patrik:   Thank you. That’s wonderful news that she’s got time on the tracheostomy mask. That’s wonderful news.

Hedda:  Yeah, yesterday she had just 3-hour trial, but today we are just trying for 5- hour trial.

Patrik:  That’s fantastic.

Hedda:   We start morning in the early 8 o’clock, I just put on the tracheostomy mask. The values in the morning said they’re okay, other than heart rate. It is a bit high.

Patrik: Right.

Hedda:  But alright, I think. We’ll see how she is behaving in the coming hours.

Patrik:  That’s great.

Hedda:  Just a moment.

Patrik:   Thank you.

Hedda:  Okay. So, that’s it.

Patrik:   And when she’s on the tracheostomy mask, are you still doing arterial blood gases?

Hedda:    Yeah. After putting her in the trachy mask, we have done one test.

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Patrik:   Right.

Hedda:    I just want to see the values; I haven’t checked it now.

Patrik:  Okay

Hedda:   Do you want me to tell.

Patrik:   Oh, that would be great if you could. It just helps. It just really helps to understand.

Hedda:   Okay. Just a moment, I’ll have a look and get back to you. Just a moment.

Patrik:  Thank you so much. Thank you.

Hedda:  Okay.

Patrik:  Okay.

Patrik:   Do you know this nurse?

Tess:   No, not even sure of her name, I didn’t catch it.

Patrik:   I didn’t catch it. But she seems to be helpful.

Tess:  Yes, indeed. Very helpful.

Patrik: That’s.

Hedda:   Hello.

Patrik:   Yes.

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• THE 5 THINGS FAMILIES DO WHO HAVE PEACE OF MIND, ARE IN CONTROL, FEEL POWERFUL AND INFLUENCE DECISION MAKING FAST, WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
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Hedda:  Hello.

Tess:  Hello.

Hedda:     Actually, the test values are absolutely great.

Patrik:  That’s wonderful.

Hedda:  I come down with the oxygen because the PO2 (partial pressure of oxygen) is good, I put her on the 35%. Now I will come down to 28%. And we will see again after that.

Patrik:   That’s great. And no issues with CO2 (carbon dioxide)?

Hedda:    No issues with the PCO2.

Patrik: Okay. That’s wonderful. And when she’s back on the ventilator, she’s just in a pressure support, or CPAP mode?

Hedda:   She is. She will be on the CPAP, but earlier she is getting no response, CPAP, PEEP 5.

Patrik:   Right.

Hedda:   And she’s doing well on that one, just very minimal support.

Patrik:    That’s fantastic.

Hedda:  Hopefully the plan is to put her in the tracheostomy mask, after the 24 hours..

Patrik:  Yes.

Hedda:     … By tomorrow. That’s the plan.

Patrik:   Yeah. Of course.

Hedda: Hopefully she will tolerate it.

Patrik:    That’s wonderful. And does she have a lot of secretion? Do you suction her very often?

Hedda:    Regarding the secretion, it’s just moderate. At one stage it was lots. But, it’s moderate.

Patrik:  That’s great. And what’s her GCS or Glasgow Coma Scale like?

Hedda:   Her GCS?

Patrik:   Right.

Hedda:    4

Patrik:  Right. So, it’s just a 4? Really is she?

Hedda:   Yeah. The motor wise, nothing.

Patrik:     Nothing.

Hedda:   And having some just movement, it’s not seizures.

Patrik:    Sure. And pupils are equal and reactive?

Hedda:  It is actually reactive but a bit sluggish. We can’t tell because it’s a bit sluggish.

Patrik:    Okay. And she’s still on, from what I understand from Tess, she’s on the Keppra, she’s on the valproate acid?

Hedda:    Yeah. She’s on Keppra.

Patrik:   Okay. And so, you are saying she’s not even responding to pain stimuli?

Hedda:   No. Even after we inflicted the pain to her.

Patrik:    Right.

Hedda:  She’s not doing anything.

Patrik:     I see. Okay. She’s not on inotropes?

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Hedda:  No, she’s not on any of those.

Patrik:   Right. And she’s absorbing feeds?

Hedda: Yeah. She’s absorbing feeds. There’s no problem.

Patrik:   And she’s opening bowels?

Hedda:   She’s opening the bowels.

Patrik: Yeah.

Hedda:   There is no complaints with that.

Patrik:   And kidneys are working? She’s making urine?

Hedda:   Yeah. She’s okay in terms of all other things.

Patrik:  All other things.

Hedda:  She’s a bit polyuric by maybe some kind of..

Patrik:   Right.

Hedda:  Otherwise she’s okay. But, she’s not that much polyuric, only in some hours of the last night..

Patrik:  Right.

Hedda:  But, she’s okay. Her potassium is a bit low, but it’s ongoing correction.

Patrik:   Yeah. And I guess she’s on insulin which probably brings the potassium down a little bit as well?

Hedda: Yeah.

Patrik:  And her blood results are fine? She doesn’t have an increased temperature. White cell count is fine?

Hedda:  Oh, those things are pretty much okay.

Patrik:  Yeah.

Hedda: So, there’s not much worry about..

Patrik:  That’s wonderful. That’s really good news. And is there a plan to mobilize her? To get her out of bed?

Hedda:  No chance. We didn’t do anything about that once sedated.

Patrik:   Right.

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Hedda:  The plan is just now maybe the trial weaning is a priority.

Patrik:    Yes. Of course, it would be.

Hedda:  Maybe later once she started a little more… But I’ll ask her regarding the plan.. I’ll have a talk with them and later and let you know.

Patrik:   Yeah. No, that’s wonderful. You’ve been very helpful, thank you so much for everything that you do.

Hedda:   Okay. I hope you understand.

Patrik:   Thank you so much. Bye-bye.

Tess:   Excuse me, I didn’t catch your name there.

Hedda: Sorry?

Tess:   What is your name?

Hedda:  My name is Hedda.

Tess:    Okay. Lovely. Thank you so very much Hedda.

Hedda:   Thank you.

Tess:     … For all the amount of the care that you’ve been giving my daughter. It’s much appreciated. Have you just come on this morning, or were you with her all night?

Hedda:  Yeah. I’m from the morning 7 o’clock to the night7 o’clock I’ll be here.

Tess:   Amazing. Thank you so much for your help. And will I see you at 2:00 do you think?

Hedda:   Okay. At what time are you’ll be there? Yeah.

Tess:   At 2 o’clock.

Hedda:   We’ll see you soon. Bye-bye. Take care.

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Tess:  Okay. Thank you very much.

Patrik:  Thank you so much.

Hedda:  Bye-bye.

Patrik:  Thank you. Bye.

Tess:  Bye-bye.

Patrik:  Bye.

Hedda:   Bye-bye.

Tess:  Hello, Patrik?

Patrik:   Yes, hang on. Do you want to go back on Skype?

Tess:   Yes. That’s fine.

Patrik:   Okay. I’ll call you there. Thank you.

Tess:   Okay. Thank you, Patrik.

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