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Today’s article is about, ” Quick Tip for Families in Intensive Care: Dad Had CPR After Cardiac Arrest with Upper GI-Bleed, 2 Days Off Sedation, Eyes Open but Not Moving!”.

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Quick Tip for Families in Intensive Care: Dad Had CPR After Cardiac Arrest with Upper GI-Bleed, 2 Days Off Sedation, Eyes Open but Not Moving!

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today I have an email from Renee who says, “My dad was resuscitated after cardiac arrest in intensive care because he had an upper gastrointestinal or GI bleed and now two days out of sedation and his eyes are open, but he’s not moving or responding. I need help to understand what’s happening.”

Thanks, Renee, for sharing your dad’s situation.

So, let’s just look at this in much more detail. If he had an upper GI bleed, he probably had a large drop in hemoglobin in the red blood cell. So, he probably needed to have multiple blood transfusions to save his life.

If he had a massive GI bleed, that might have been one of the reasons why he went into cardiac arrest and needed to be resuscitated. So, it would have had multiple blood transfusions including red blood cells, including maybe platelets, and fresh frozen plasma, depending on the coagulation numbers of his blood such as INR (international normalized ratio), APTT (activated partial thromboplastin time), and platelet numbers. It probably would have been started on a somatostatin or pantoprazole infusion, which is a proton pump inhibitor to reduce the acid production in the stomach that can cause an upper GI bleed.

Well, first off, he would have been in the best place for that to happen.

Imagine, an in-hospital arrest is much easier to deal with than an out of hospital arrest because, in a hospital, you have a medical emergency team more or less on standby, whereas, if this happens at home or on the street or wherever, you have to call an ambulance and, that might take some time, whereas in the hospital, the medical emergency team might be available or should be available pretty quickly.

But then the next question is, how long did they resuscitate your dad for? Did it take two minutes? Three minutes? Did it take 30 minutes? If it took a long period of time, has there have been some brain damage? Have they done a CT scan of the brain? Have they done an MRI scan of the brain? Have they done an electroencephalograph of the brain to check for brain damage?

Have you spoken to a neurologist?

Now, you’re saying he’s been out of sedation for two days. But the question once again is, is there brain damage? What sedatives have he been on? Has he been on short acting sedatives such as propofol? Has he been on long-acting sedatives such as midazolam or versed? Has he been on any other sedatives such as Precedex for example, also known as dexmedetomidine?

Also, is he on morphine or on fentanyl or any other opiates? If so, how much is he on? Right. When someone is intubated, in an induced coma, they need sedatives and opiates in order to tolerate the breathing tube. But the question is, if he’s not awake, he might be in a natural coma, maybe he hasn’t had a lot of sedatives. What is his Glasgow Coma Scale? And those are all questions that should be answered here.

Also, is his liver functioning, okay? Are his kidneys functioning, okay? The reason I’m asking that is let’s just say there’s an element of kidney or liver failure, it might take him longer to wake up because sedatives or opiates cannot be either excreted through the kidneys quick enough or cannot be metabolized through the liver. So therefore, they’re lingering around for longer in the body system delaying waking up. So, those are the questions you should be asking.

Also, has he had a gastroscopy for gastrointestinal bleed? Have they found the source of the bleed? Has it stopped? Have they restarted his nasogastric tube feeds or if he has a PEG (percutaneous endoscopic gastrostomy) tube feeds that will most likely also limit the risk of bleeding again. But if he’s still bleeding, how can they stop it? Would he need some TPN in the meantime, some total parental nutrition in the meantime? Those are all questions you should be asking besides why he’s not waking up. It’s very important to find out why he is not waking up and you want to get to the bottom of that.

However, as you can see, there’s a much bigger picture emerging here.

Also, if he was resuscitated not only through CPR (cardiopulmonary resuscitation), but also with blood transfusions, he probably was also on vasopressors or inotropes, or he might still be on them because of hemodynamic instability. He would have lost a lot of blood, dropping his blood pressure; therefore, needing the fluid resuscitation that I just spoke about. He would probably also be needing vasopressor or inotrope support. He’s still on that? Vasopressor or inotrope support in ICU is considered life support.

So now you can see that there’s a much bigger picture emerging here that you need to find out what’s exactly is happening.

Also, what has led to the GI bleeding? Is it stress? A lot of patients in ICU undergo a lot of stress and stress can cause gastric ulcers or stomach ulcers which can lead to GI or gastrointestinal bleeds.

So, that is my quick tip for today.

I hope that helps and understands that when someone is in intensive care, it’s very complex. The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care. And this is once again exactly what you are dealing with here.

Now, if you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to support@intensivecarehotline.com.

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There you have access to me and my team 24 hours a day in a membership area and via email and we answer all questions, intensive care related.

I also offer one in one consulting and advocacy for families in intensive care over the phone, via Zoom, via Skype, via WhatsApp, whichever medium works best for you. And I talk to you and to your families directly, helping you to understand what’s happening, giving you tips and strategies on how to manage intensive care teams. I also talk to doctors and nurses directly asking all the questions that you haven’t even considered asking but must be asked so that you can make informed decisions, have peace of mind, control, power, and influence.

I also represent you in family meetings with the intensive care team where I’m your clinical representation on your team, once again, making sure that you can make informed decisions, have peace of mind, control, power and influence and that you have someone that can prepare you for those meetings because you shouldn’t be going into any of those meetings without a representation or without a written agenda.

Now, we also offer medical record reviews  in real time. If you want a second opinion in real time, please contact us for that. We also offer medical record reviews after intensive care in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

Now, if you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.

Kind regards,

Patrik

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