Why is my Mom Not Waking Up After Being in an Induced Coma in ICU?
Published: Sat, 04/22/23
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
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, Lloyd, as part of my 1:1 consulting and advocacy service! Lloyd’s mom is in the ICU and he is asking why his mom is not waking up after being in an induced coma.
Paul: And the other day was, yesterday was cloudy, and the day before.
Patrik: Right. And sorry, I didn’t get that. What did you say they were giving her?
Lloyd: They were giving her a stimulant. Oh, I don’t know. They put it in her
arm. If I find it, I’ll let you know.
Patrik: Not melatonin?
Lloyd: No, not melatonin.
Patrik: Okay. There’s one big question mark for me here. Why is she not awake? Why? That’s the big question mark to me. Especially if she was awake last week. What has changed?
Paul: Well, it’s the
sedation part. They keep on putting her on fentanyl. I think the sedative is affecting her ability to really move. I think that’s what it
is.
Patrik: Okay. How much fentanyl is she getting?
Paul: So, well, they were putting 2.5, they were pumping her with 2.5. We can read it on the
feeder, so it would say, okay, 2.5. Right, Lloyd?
Lloyd: Well, the lowest, at one point I asked them to give her the lowest dose, which was like 2.5. But when she had the antibiotics, it was 12.5. She was super calmed
out. She was sleeping the whole day.
Patrik: Right. Per hour?
Paul: And she wasn’t responding.
Lloyd: For hours, like a whole, what is it from night, Paul, you were here when they did that? Was it in the evening, throughout the night when they figured out, they messed up with antibiotics? Well, not that they messed up, they did-
Paul: Yeah, it was in the evening. Well, they gave it to her around … Because during the day they wanted to wean her off of it. And then it looked like she was in a little bit of pain. And so I don’t know why they gave her 12.5 of fentanyl.
Lloyd: It’s such a high dose. And we don’t know if it was a mistake or if they intended to do that.
Patrik: Well, okay. When you say 12.5 of fentanyl, do you know whether that’s microgram per hour?
Paul: It’s MCG.
Patrik: Okay. Microgram per hour. Okay. Okay. That is a, I’d say it’s an average dose.
Lloyd: An average. Okay.
Patrik: But the question, especially for her weight, but the question is, what else are they potentially giving? Do you have access to medical records?
Lloyd: Yes, we do.
Patrik: Okay. Can you see what list of medications she’s on?
Lloyd: Medication-
Patrik: While you’re looking.
Paul: So she’s on nebulization.
Patrik: Okay. Yeah. No, no.
Paul: She’s on Acetylcysteine.
Patrik: Acetylcysteine, yep.
Lloyd: And then she’s on amantadine hydrochloride. It’s a nasogastric tube daily.
Patrik: Yep.
Lloyd: There are amino acids – protein hydrolysate; there’s Bayer aspirin; there’s Aztreonam injection 1,000 milligrams.
Patrik: Right.
Lloyd: I don’t know if I’m saying this right. I’m sorry.
Patrik: It’s okay.
Lloyd: And then there’s Peridex. It says 15ml 2 x day.
Paul: That was what they started using on her initially and then they switched to fentanyl.
Lloyd: There’s Tylenol. They’re giving her Tylenol.
Paul: Sure.
Lloyd: They’re giving albuterol.
Patrik: Albuterol. Yep,
that’s another nebulizer.
Lloyd: They’re giving her dextrose, dextrose glucose, glucagon. There’s Hydralazine.
Patrik:
Hydralazine, yep.
Lloyd: Yes. There’s labetalol and sodium chloride.
Patrik: Okay. Well, there’s no-
Paul: I was going to say, I’m looking at a picture of the machine with 125 mcg for the fentanyl.
Patrik: Okay. There’s no indication from what you’ve
shared there that she’s on any sedatives. No.
Lloyd: Well, you’re right. But the other day there was fentanyl on here.
Patrik: Sure.
Fentanyl technically speaking is not a sedative. Fentanyl is an opioid or a painkiller, but obviously does have some sedative effects. But technically speaking it’s not a sedative.
Lloyd: Look in the beginning, Paul, I think there was Peridex that she was given in the beginning, and then they put her off of Peridex.
Paul: I don’t see it anymore.
Lloyd: You don’t see it anymore, but-
Paul: Because I’m looking off of her portal.
Patrik: Yeah, no, that’s good. Okay, then now that we established that there’s probably no sedative, why is she not awake? What has changed? And no one has come
to you and said, “Hey, before extubation on Wednesday she was awake, now she’s no longer awake. X, Y, and Z has changed.” No one has shed any
light on that?
Lloyd: Well, when you say she’s not awake, yeah, no, I mean, she sleeps a lot now. She’s sleeping a lot. But right now, her eyes are open and it’s been open.
Patrik: Right, but when I say awake, I mean she’s not following instructions. That’s what I mean by not being awake.
Lloyd: Oh yeah. Okay, sorry. Okay, thank you. Yeah, no one’s answered that question. I’ve asked, and no one’s unable to tell me.
Patrik: Have they done a follow-up CT scan or MRI scan of the brain since Wednesday?
Paul: Yes. They’ve been doing CT scans every day.
Patrik: Oh, really?
Paul: No, they’ve been doing chest scans.
Patrik:Chest X-Ray. Yeah. No, no, no, no. There’s a difference there.
Have they done a follow-up brain scan?
Lloyd: I’m double checking. I think they did.
Paul: They did an MRI.
Lloyd: Paul, I think remember the day you were asking if they were doing this? That was a couple of days ago. You asked them if they were going to do a CT scan. They said they were going to do it that night.
Patrik: And have they done that?
Lloyd: Yes-
Paul: They are doing the chest.
Lloyd: They did. I think they saw additional … Now I’m trying to remember. All these days are gelling along with each other. I think there was more white spot on, but it was nothing acute. No additional.
Patrik: Yeah, no additional.
Lloyd: But they haven’t done it since. Yeah, but they haven’t done anything-
Belle: I have 11th, Wednesday, November 11th was the last one.
Patrik: Right. Okay.
Lloyd: November 11th is perfect then.
Patrik: And the carotid stent they did, they claimed that was a success, or?
Lloyd: Yeah, the doctor called, and he said everything went well.
Patrik: Okay. That’s a bit strange to me that she’s going from a stroke to obeying commands, then going for surgery and her neurology has deteriorated. That doesn’t quite add up to me.
Lloyd: Yeah.
Patrik: Unless something has happened-
Belle: There are the findings of the CT scan, I
just found them. It says re-demonstrated stable sub centimeter, left round, thalamic hematoma, minimal surrounding pathogenic edema without significant mass effect. Continual evolution of pontine infarction without gross hemorrhagic transformation. No new acute intracranial findings, orbital contents, soft tissues, and oscillated structures are unchanged.
Patrik: Okay. All right. With the insulin quickly, is she diabetic?
Lloyd: No, just as a result of the stuff that was going on.
Patrik: Yeah, no, that’s fair enough. A lot of patients in ICU are on insulin temporarily and they’re not diabetic. Yeah, no, that’s good. That’s good.
Lloyd: Yeah, she’s normally not diabetic.
The 1:1 consulting session will continue in next week’s episode.
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