How to Stay Positive Whilst our Dad is in the ICU, Ventilated with Pneumonia?
Published: Thu, 10/19/23
Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COMw 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, Iyah, as part of my 1:1 consulting and advocacy service! Iyah’s dad is in the ICU and she is asking how to stay positive whilst their dad is in the ICU, ventilated with pneumonia.
Iyah: We’re still
waiting for Mom to be joined via Zoom, and also my younger brother via Zoom.
Dr. Shelby: Do you want to start without them, or wait a little bit more?
Arlene: Call Liza.
Michael: Liza? You’re going to call
Liza?
Arlene: Yeah, she told me to.
Iyah: Why don’t we just do a call speakerphone?
Michael: Yes.
Iyah: There’s no need for her to see anything.
Michael: Yeah,
she would like the speakerphone thing.
Iyah: Because it’s too much to do with Zoom.
Iyah: While we have my friend, Patrik, on the line, Patrik, would you like to introduce yourself to Dr. Shelby?
Patrik: Yeah, sure. Thank
you. Thanks Iyah. Look, I’m a family friend, and I do have a background in critical care nursing. So I’m trying to help the family making sense out of what’s happening, and trying to help them to make a decision that probably best for their dad.
Liza: So, yeah, I’d just like to say, I’ve listened to Patrik and I really respect his experience and what he has to say. I really think invaluable insight into how ICU units work, and where we can go from here.
Dr. Shelby: Yeah, great. So to introduce myself, my name is Dr. Shelby, I’m with the palliative care team, and we’re a consult service here in the hospital.
And our role is to help patients and families who are
going through really serious illnesses try to figure out what care makes the most sense, what the future may be like-
Iyah: oh yeah?
Dr. Shelby: … and what to do in case of emergencies that may come up. And so we had a consult regarding your dad’s care, and does one of you want to give me your understanding of what brought your dad into the hospital, and what’s happened since then, just so I know that we’re all on the same page?
Iyah: Yeah, it started off with neck pain the night prior to going to the ER (Emergency Room), Tuesday night.
Arlene: Oh, was it?
Iyah: He was up all night, did not get any sleep. He was complaining about not having comfort, his neck was hurting really
bad. So I kept helping him with icing and trying to get him a little more comfortable. This was from midnight all the way to-
Iyah: And then I had to go to sleep. So then I wake up around 7:00 AM and he’s still complaining about neck pain,
he hasn’t slept at all.
Iyah: And then he said that he couldn’t breathe a couple of hours later, and when he couldn’t breathe we started giving him his asthma inhaler, and also the powdered asthma. So we just kept giving him his medicines to assist him, and none of them was helping him. So by 9:00 AM we had to call the ambulance. And he came to the ER.
Dr. Shelby: And what was he diagnosed with, since he arrived here at the hospital?
Iyah: He was not diagnosed with anything initially, so he came 9:00 AM at the ER, and he was given oxygen through the oxygen tank, through the nostril. I don’t recall what his O2 saturation-
Arlene: Yeah, his diagnosis was, that he had neck pain from-
Michael: He said because he was sitting down in his chair, that’s when he got that pain, so they discharged him around 6:00 PM, and
that’s when I went there, I stayed around 7:00 and 8:00-
Arlene: … stooping down. That was the diagnosis from the hospital, that discharged him, the ER.
Michael: … debating while go back to the ER. Eventually tried to get him in my car, could not get him in there comfortably, so I called the ambulance to come get him. And that’s when that following night I was with him in the ER until about 3:00, my sister relieved me.
Arlene: 3:00 AM.
Michael: And they gave him the mask, oxygen, while I was there with him the whole time.
Iyah: Yeah, and that caused a lot of discomfort for him because he was pleading for water, but he had fluid overload so he couldn’t drink any water.
And his oxygen saturation was between 86 to 91. So, initially when he was discharged from the ER that evening the doctor did mention about some fluid in the lungs (pleural
effusion), but he didn’t have any concerns about it, and because he didn’t have any concerns about it I didn’t really think to ask any questions about it. What his concerns were, his oxygen saturation was at 91, and I told him, I check his O2 saturation with the finger oximeter, is that what it’s called?
Dr. Shelby: Pulse oximeter?
Iyah: Yeah, that. And every now and then I’d see 88, I’d see low 90. So, I did tell the doctor
that doesn’t seem unusual, I’ve seen that number before. So then he said, “Well, we’re going to discharge him then.” And I should have stopped him there and said, “Let’s not. Let’s send him to a room or something and further check.”
Dr.
Shelby: Hard to know. These things change from minute to minute, so it can be hard to know.
Iyah: And also with the doctor saying that he had fluid in his lungs, that should have been a red flag to me as well. But I’ve
heard that before, when he had fractured ribs back in July of this year, he had fluid in his lungs as well, and the urgent care doctor didn’t really have concerns. He had checks at x-ray, but there was no concerns, and said, “It doesn’t seem emergency.” So I’ve heard it before,
that’s why, again, didn’t throw a red flag at me.
Dr. Shelby: That’s fine. Well I’ll jump ahead a little bit. So from my understanding, he has longstanding history of end-stage renal disease.
Iyah: Say that again, please.
Dr. Shelby: He has a longstanding history of end-stage renal disease?
Iyah: Yes.
Dr. Shelby: He had a transplant in 1998.
Iyah: Yep, 23 years transplant.
Dr. Shelby: Which is incredible, and he’s been on immunosuppression that whole
time. Age history of atrial fibrillation, coronary artery disease and a prior stroke a few years ago with some persistent left-sided weakness. And also some mitral valve stenosis, so narrowing of one of the heart valves. And you’re right, when they-
Iyah: Is there a heart valve that you can specify?
Dr. Shelby: The mitral valve.
Iyah: Mitral, yeah.
Dr. Shelby: Mitral valve stenosis.
Iyah: I don’t know anything, is that upper or lower?
Dr. Shelby: So it’s the lower left. So it’s the valve that goes from the left atrium to the left ventricle.
Iyah: And is it output or input?
Dr. Shelby: It’s narrowed, so it’s just harder to get blood flow through that valve. So it usually causes backup pressure to the lungs, in the left atrium.
Liza: So, my question about this narrowing of her valve, is it because she has been active? Or is it a build up-
Dr. Shelby: It can happen just over time as you get older. There’s not usually a clear specific cause unless there’s a prior illness that may have led to it, but oftentimes it just happens. Depending on the severity, I don’t know what the severity of how narrow it is. Sometimes there are remedies that cardiology can do, but they wouldn’t do them when he’s so ill, what he is right now, so it’d have to be assessed later on in the future. But right now
it’s not the top concern.
Iyah: Correct.
Ron: It isn’t a matter of stretching it out, it’s not like putting a stent or a balloon and stretching out an artery that has filled up with plaque, it would have to be actually replaced with probably either a pig valve or an artificial valve. Because it has to open and close.
Liza: Okay. Good to know, thank you.
Dr. Shelby: So, came in, and from our records, came in with sepsis. So low blood pressure-
Ron: But pneumonia can also cause sepsis. Did he have low blood pressure?
Iyah: No.
Ella: His blood pressure was high.
Iyah: No. I didn’t see any of
that.
Ella: High white …
Iyah: He had high white blood count.
Ron: Yeah.
Iyah: Iron, right?
Ron: I believe it was probably early stages.
Iyah: But then again, he did have steroid injections, cortisol injections on his right thumb and also on his right bottom foot for some things back-to-back weeks.
Ron: Right.
Iyah: Two weeks prior.
Dr. Shelby: But regardless, he had abnormal vitals and labs that we call sepsis. And when there’s an infection, that’s tied to that, that’s sepsis related to an infection. But he was put on IV (intravenous) antibiotics. He ended up needing to be intubated. He’s been on a ventilator for a few weeks now. He’s been back
on antibiotics for the last few days as well since the 23rd.
Iyah: Because of a new bacteria.
Dr. Shelby: Possibly.
Iyah: No, that’s what it is. He had a low-grade fever.
Ron: Well, it could be the same one he had before.
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