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Today's article is about, “ICU Family Meeting: How to Advocate Effectively (With Scripts You Can Use)”

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ICU Family Meeting: How to Advocate Effectively (With Scripts You Can Use)

Good morning, good afternoon, good evening, wherever you are.

Thank you so much for joining the YouTube live here, ICU Family Meetings: How to Advocate Effectively.

I’ve also got scripts for you that you can use one by one. So, are you facing an ICU family meeting and you don’t know what to say? In this YouTube live, myself, Patrik Hutzel, I’m a very experienced critical care nurse consultant. I’ll give you word for word scripts, proven strategies, and step-by-step guidance so you can advocate effectively for your critically ill loved one in ICU family meetings.

So, we’ll be focusing on what to say before, during, and after an ICU family meeting, scripts you can use right now if you have a family meeting coming up, how to stop ICU from pressuring you into decisions you’re not ready for, how to ask the right questions that get you real answers, how to prevent your loved one from being sent to LTAC (Long term Acute Care) or a nursing home or any other destination you don’t agree with. When intensivecareathome.com is the right alternative and how to bring it up. And go to intensivecarehotline.com right now to get 24-hour support.

If you have a loved one in intensive care, explore home care options such as Intensive Care at Home and download your free instant impact report at intensivecarehotline.com. So, before we go into the meat of today’s topic, what makes me qualified to talk about today’s topic? Again, my name is Patrik Hutzel. I’m a critical care nurse with over 25 years of critical care nursing experience in three different countries where I worked as a nurse manager for over five years in intensive care. I’ve been consulting and advocating for families in intensive care with intensivecarehotline.com since 2013, and I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our testimonial section or you can verify it on our intensivecarehotline.com podcast section where we have done many client interviews.

Now, I’m also the founder and managing director of intensivecareathome.com with Intensive Care at Home. We also have saved many lives for our clients in intensive care by taking them home with 24-hour critical care nursing, 24-hour intensive care nursing for predominantly long-term ventilated adults and children with tracheostomies, adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) ventilation, tracheostomies without ventilation, home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotics, home IV magnesium, home IV potassium infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home.

We are also looking after patients on cough assist, SPC (Suprapubic catheter) management, IDC (Indwelling Catheter) management, PEG (Percutaneous Endoscopic Gastrostomy) tube, as well as nasogastric tube, and nasojejunostomy tubes at home.

We’re also providing Level 2 and Level 3, NDIS support coordination as well as WorkSafe and TAC (Transport Accident Commission) case management in Victoria. And like I said, you can also look up our testimonials at intensivecareathome.com. We are providing a genuine alternative for our clients to a long-term stay in intensive care. We employ hundreds of years of intensive care nursing experience combined in the community and no other provider brings more expertise to this space than we do. We’re currently operating all around Australia with Intensive Care at Home in all metropolitan, regional and remote areas, pretty much all around the country.

Now, in today’s topic, obviously ICU family meetings in intensive care. And like I said, I do have scripts for you that you can use just as easy. You can copy and paste almost, why am I choosing this topic today? I’ve been in, I don’t know, hundreds of family meetings in ICU either when I worked in ICU or now as a consultant and advocate, whether it’s with intensivecarehotline.com or with intensivecareathome.com.

And before we go again into today’s topic, if you’re watching this live right now, or if you’re watching the replay, thank you for watching either live or on replay.

If you have a family meeting coming up in ICU or you’ve just had one and you walked out of that room feeling confused, overwhelmed, pressured, or like you didn’t get the answers you needed, you are exactly in the right place. And like I said, I have been in so many family meetings myself, either when I worked in ICU or now as a critically care nurse consultant advocating for families in intensive care. Been in so many meetings that I understand the dynamics of these meetings. And I’ve been helping families just like you navigate some of the most difficult moments of their lives inside intensive care units.

And today, right now, I’m going to give you something that I wish every family had before they walked into that family meeting in intensive care. I’m going to give you the scripts, the actual words, the questions, the strategies, everything you need to walk into that room and advocate effectively for your critically ill loved one. Because here’s the truth that most families in intensive care simply don’t know and that ICUs are not going to tell you have, and that is actually that you have more power in that family meeting than you think. But only if you know what to say, only if you know when to say it, and only if you know how to say it, and only if you know what questions to ask.

So, today, all of that changes, I will give you the tools today. Also one of the biggest questions that you should be asking yourself when you do go into a family meeting with intensive care teams, should you even go? That is a very important question. I will break all of that down for you in a moment.

Now, this is a YouTube live. That means I can hear from you live. I can see your comments. If you’re going through this right now, if your loved one is in ICU and you have a family meeting coming up, I want you to type in the comments right now. Tell me. Tell me your situation.

If you like my video, subscribe to my YouTube channel, click the notification bell and share this video with anyone that will benefit from it, especially if they have a loved one in intensive care. So, what is happening with your loved one? What is the ICU team telling you? Are you feeling pressured? You don’t have to share anything you’re not comfortable with, but the more you share, the more I can tailor this entire session to your situation, or if you’re watching it on replay, I can make a video about your situation later. Leave as many comments as you like. I read every single one of them and my videos are all content creations from your questions and from your feedback.

So, many families in intensive care don’t even know that this information exists, so share it with them. Share my information with them so I can help as many families in intensive care as possible. And just you know where to find us outside of YouTube, everything we do, all of our resources, one-on-one consulting, our membership for families in intensive care, medical record reviews, all of that is there at intensivecarehotline.com. I’ll put the link in the description below. We are available 24/7 if you need to speak to someone today.

So, let’s now move on to why family meetings in ICU are so difficult and why most families fail miserably in those meetings.

Now, before I give you the scripts and the strategies, I need to explain why family meetings in ICU are so incredibly difficult because it’s not just that you don’t know what to say. There are specific reasons why families walk out of these meetings feeling like they’re lost and understanding those reasons is the first step to change that. Point number one is the power imbalance, but I also want to give you a mindset shift there straight away. It’s the perceived power imbalance. You perceive the ICU team having all the power and you have none. Well, the first thing is to change that perception because that’s what it is. It’s just a perception. Change your perception.

Go into those meetings and think you have all the power. Walk in with your head held high, shoulders out, straight body language. Most intensive care teams can see right away that families are intimidated and you can change that by just changing your outlook, change your body language, speak loudly, speak clearly. Because I’ve been in so many families, families can’t even talk straight because they feel the pressure. They think they have no power. You can change all of that. It’s all in your head. On one side, you have a team of doctors, intensivist, specialists, sometimes consultants, ICU nurses, ICU nurse managers, nurses, nurse practitioners who do this every single day.

They know the language, they know the process, they know the dynamics, they know exactly how these meetings go. They know what to say, they know when to say it, they know how to say it, and they also know what not to say.

On the other side, you have you and your family and you are probably sleep-deprived. You’re probably terrified. You may not have slept properly in weeks. You don’t understand half the medical terminology being used and you’re being asked to make decisions, often life or death decisions, or at least be part of decisions that could literally determine whether a loved one lives or dies. And that is not a fair fight, and the ICU team knows it.

The second thing, and I’ve seen this happen hundreds, if not thousands of times, is that ICU teams often use pressure tactics. Now, I’m not saying every ICU team does this deliberately, but the way these meetings are structured and the way information is delivered often feels like pressure, even when it’s not intended that way. ICUs are high pressure environments, people’s lives are often hanging at a thread, and ICU teams don’t have a lot of time because they are busy saving lives. And I will also say that, and I’ve said it on this channel many times, there’s a lot of good things happening in ICU. I’ve worked in that environment for over 25 years. There’s a lot of good things happening in ICU.

Unfortunately, the people that come to us are the situations where things are not going well, where things are not straightforward. So, here’s what that looks like in practice. They may tell you that your loved one is not improving.

They may use words like futile or no meaningful recovery. They may present you with a timeline or multiple timelines if things don’t improve in the next 48 hours, and those statements, of course, create urgency. And they may suggest options like withdrawing life support or transferring to an LTAC or to hospice or to palliative care or nursing home before you had the chance to fully understand the situation.

And when that happens, when you feel that pressure, most families do one of two things. They either agree prematurely without enough knowledge and without enough context, and they agree to whatever is being suggested because they don’t know how to push back. They don’t know what questions to ask. They don’t know their rights. They don’t know what to look for. And they don’t know how to manage doctors and nurses in intensive care. I can tell you it is possible to manage doctors and nurses in intensive care, as long as you have someone like myself on your side or families freeze. They say nothing because they don’t know what to say, and then the decision is made without their real input.

Let’s now also look at the information gap or the perceived information gap.

So, the third reason family meetings fail for families is what I call the information gap or perceived information gap. ICU teams have all access to all of your loved ones’ medical records. They’ve been monitoring the numbers, the trends, the scan results, everything. But most of that information is never shared with you in a way that you can actually understand. One thing that I’ve been saying for the longest is that ICU teams are telling families in intensive care, not even half of what’s going on.

So, you’re sitting in that meeting and you’re nodding along and you’re thinking, you understand, but you actually don’t have the full picture. When you don’t have the full picture, you can’t advocate. Effectively, you don’t also don’t have enough perspective. If you’ve seen thousands of critically ill patients and their families like I have, you have a lot more context. You can put things in perspective. You know what things mean, you have a much better outlook on things. And that’s exactly why I created intensivecarehotline.com because families in intensive care deserve to understand what is happening.

They deserve to know the right questions to ask, and they deserve to have someone in their corner who knows how the ICU works from the inside. So, I know how hard this is for you right now. I want you to know by the end of today’s session, you are going to walk away with tools that will genuinely change how you show up in that room, so please bear with me.

Now, let’s now look at the three phases of an ICU family meeting and how to win each one of them. So, here’s what I want you to think. Here’s how I want you to think about an ICU family meeting. I want you to break it into three phases. And in each phase, there’s a specific strategy and specific scripts you can use.

The three phases are phase one before the meeting, phase two during the meeting, phase three after the meeting. Most families only focus on phase two, what to say when they’re in the room. But honestly, phase one, what you do before you walk in is where the real advocacy happens. And phase three, what you do after is what determines whether the decisions made actually get followed through on. So, let’s go through each one before the meeting. Phase one is preparation. And I cannot stress this enough. Preparation is everything. This is old saying goals like if you’re failing to plan, you’re planning to fail.

So, the number one mistake families in intensive care make is walking into a family meeting with no preparation at all. They get a phone call or a message saying, “Hey, we need to schedule a family meeting.” And they show up with no idea what’s going to be discussed, no questions written down, no strategy whatsoever. Here’s what you need to do before that meeting happens.

Number one, think about whether it’s even advantageous for you to go into a family meeting. And I will talk about that in more detail a little bit later, why in some cases it will work against you if you are actually going into a family meeting. So, that leads me to the next step.

So, let’s just say you’ve been told we want a family meeting tomorrow at 3:00 PM, for example. Your first thinking needs to be, okay, is it going to be advantageous for me to go into a family meeting? So, what you need to do then is go back to the intensive care team and ask them for a written meeting agenda. Let me say that again because it is so important. If an ICU asks you to go into a family meeting next day, 3:00, whatever, or even on the same day, your first step of thinking needs to be, is it advantageous for me and my loved one to go into a family meeting or not? In order to answer that question, you then need to ask the intensive care team for a meeting agenda in writing.

Now think about it. Every meeting in life, especially in the business world, has a meeting agenda. So, why would there be no meeting agenda for patients in intensive care where it’s often life or death? So, rule number one, ask for an agenda in writing and ask them to send you the agenda for this family meeting so you can prepare. And if they say they can’t do that, that’s a huge red flag, pushback and say, “We want to be fully prepared so we can participate meaningfully in this meeting. Can you tell us the main topics that will be discussed and ask them to write it down and ask and write down what I just told you?”

Number two, request an update on your loved one’s current condition before the meeting. Ask the bedside nurse or the intensive care specialist before the family meeting, can you walk us through where things stand right now? What are the latest lab results? What other trends has anything changed in the last 24 to 48 hours and listen and this way you walk into that meeting with current information, not just the information they choose to present.

Number three, get access to all medical records. Once again, I would not go into a family meeting without having access to all medical records and without having someone else that understands intensive care inside out, look at those medical records so that you can be sure that what they’re telling you is actually accurate. One thing we do here at intensivecarehotline.com is we do review medical records on a regular basis. So, we can look at those medical records and explain things to you. And just if ICU teams want to make it difficult for you to get access to the medical records, just the first thing you need to think about is what is it they have to hide? What is it that you can’t see? Very important question to ask.

Number four, write down all your questions, all of them. Even if you think they’re silly, even if you think you already know the answer, write everything down because here’s the key. Bring those questions with you on paper or on your phone or on your iPad, whatever device or piece of paper you use.

Because when you’re in that room under that kind of pressure, your mind goes blank. I guarantee it. Having your questions written down means you don’t lose them.

Now, as a bonus tip here also, because I’ve been in so many family meetings, often what intensive care teams do, they might put glass of water on the table for everyone that’s going there, but they also often put a box of tissues on the table, almost implying that you will start crying. I think it’s also important to control your emotions whenever you can, which I know is also easier said than done, but they’re also almost implying, “Oh, we’ll have bad news for you, so we better put a box of tissues on the table,” right? So, just be very mindful of the dynamics in those family meetings and they know how to present things. They know how to present things very bluntly so that you will start crying.

Now, I’m going to give you specific scripts for this phase too, what you actually say during the meeting, but first let me quickly check any comments, want to see what you’re dealing with right now. Do you have a family member in intensive care right now? Are you looking for advice for a family meeting? Type it into the chat panel. Now, let’s look at what to say during the meeting. Let’s look at the scripts. All right, this is where it gets really valuable. Phase two in the meeting, the actual meeting, what to say. And once you’ve decided confidently that you can go into a meeting and that you are prepared, don’t go into a meeting if you’re not prepared.

Do not feel compelled to go into a meeting if you think it’s not a good idea. If you think you’re not prepared, if you think they’re withholding information before you go into the meeting, because if they’re withholding information, if you don’t have access to all medical records, if you don’t have a second opinion, if you only have selective information from what they choose to tell you, you are already on losing ground. Make sure you have as much information as possible before you go into a family meeting. Make sure you have advocacy on your side. So, I’m going to give you scripts now, real usable word for word scripts for the most common situations you will face in ICU family meetings.

Write these down, screenshot them, share them with your family members because these actually work. So, when the ICU team says your loved one is not improving, this is one of the most common things ICU teams say in family meetings, and most families hear it and their heart thinks. They think it’s over. 

There’s nothing we can do. But here’s what you need to understand. Not improving is a very vague statement. It can mean a lot of things and you need to get specific. So, when they say that here’s exactly what you say, thank you for that update. I want to make sure I fully understand what you mean. Can you be more specific which numbers or which markers are not improving?

And can you compare today’s result to where things were 48 hours ago and 72 hours ago? I want to understand the trend, not just today’s snapshot. Why does this work? Because it forces them to show you the data, not just their opinion. Opinions are dime and a dozen. It’s important that they can back up their opinion with data. Not just a general statement, the actual numbers, the actual trends. And once you can see the trends, you can ask intelligent follow-up questions and here’s the follow-up. And just to be clear, when you say not improving, does that mean things are getting worse or does it mean things are staying the same?

Because staying the same is not the same as getting worse and in critical illness, sometimes stability is progress. That last line is critical. I’ve seen families turn entire conversations around with that one statement because many ICU teams will present stable as not improving, but stability in ICU, especially after a major acute event, can actually be a very positive sign. And if you’re not sure whether stability is a positive sign in your loved one’s specific situation, that’s exactly what we help with at intensivecarehotline.com. You can call us, you can book a consultation, the link is in the description.

Let’s look at script set number two, when they suggest withdrawing life support or limiting treatment. Now, this is an incredibly difficult topic. I know. If the ICU team has brought up withdrawing life support or limiting treatment or making a loved one or wanting to make a loved one a DNR (Do Not Resuscitate) or an NFR (Not for Resuscitation), I absolutely know how devastating that feels, but I need you to hear this. You don’t have to agree to anything in that meeting. You have the right to ask questions. You have the right to take time and you have the right to get a second opinion. Here’s what you say. We appreciate you sharing with us.

We understand this is a serious situation, but before we make any decisions we need to make, we need more time to process this information. We would like to request the 48 to 72 hours our hold before any changes are made to the treatment plan. We also want to explore whether a second opinion is appropriate at this stage, and we want you to continue with best possible care and treatment. This is your script. Write it down, memorize it, because in the moment when emotions are running high, you won’t be able to think of those words on your own. And here’s what you say if they push back and say, “We really feel the time has come.”

You can say, “We hear you and we respect your clinical opinion, but this is our last one, and we need to be confident that we have explored every option before we agree to anything. We need time, at least 72 hours, maybe even more.” And most of the time, and most of the time, I can assure you of that, they will agree to that because legally and ethically, the family has a significant role in these decisions. And if they don’t agree, that is a massive red flag and you need to escalate immediately. And escalating is something we help families with every single day at intensivecarehotline.com. We can represent you. We make the calls on your behalf.

We review the medical records and tell you exactly where you stand.

Intensive care teams cannot withdraw treatment without patient or family approval because that could be perceived as euthanasia or even as murder or homicide. So, make sure you know your rights. The legalities are on your side. And also as a side note, we have saved many lives in those situations where ICU team pretend they can just kill someone. They just pretend they can end someone’s life without any repercussions. And just often with one phone call, we turn these situations around because we know and understand patient and family’s rights. Next. And also, before we go to the next topic, one more bonus advice here.

You have to ask yourself, where’s the rush and where’s the urgency to end someone’s life? Where’s the rush? Where’s the urgency to kill someone?

There should be a rush and urgency to treat your loved one. That’s where the rush and the urgency should be. Unless you and your loved one think it is in their best interest to let them go. So, let’s now look at when they suggest transferring to LTAC or a nursing home, this is another incredibly common scenario, especially when your loved one has a tracheostomy or is on long-term ventilation or has been in ICU for an extended period.

The ICU team will often say, “We think it’s time to transfer your loved one to a long-term acute care facility or a skilled nursing facility.” That is predominantly for our audience in the U.S. because LTACs only really exist in the U.S. And I need you to understand, in many cases, this transfer can seriously harm your loved one’s recovery. LTAC facilities are not set up to provide the same level of care as an ICU. LTACs are set up to save money. The outcomes are often worse, and once your loved one is out of the ICU, it is much harder to get them back. So, here’s what you say. Before we agree to any transfer, we’d like to understand the full picture.

Can you explain exactly why you’re recommending this transfer? What specific clinical criteria are not being made for my loved one to stay here and what are the alternatives? We would also like to know, is intensivecareathome.com an option that could be explored before we agree to a transfer to LTAC. The same is applicable for families in intensive care in Australia, for example, when ICUs say that your loved one needs to stay in ICU for long periods of time. That’s when you need to bring up Intensive Care at Home as an option. Especially that part, bringing up intensivecareathome.com as an option is something that can genuinely change the conversation.

Intensivecareathome.com is a service that provides 24/7 critical care registered nurses in your loved one’s own home. It is a genuine alternative to a long-term stay in intensive care and also a genuine alternative to an LTAC in the United States. It’s been proven, it works, and it has worked for over 25 years now. And if you want to know more about Intensive Care at Home, visit intensivecareathome.com. I will now also put the link to Intensive Care at Home in the chat pad so you can visit Intensive Care at Home for more information.

Okay. Again, if you have any comments, please show me your hand, what you’re dealing with. I want to know what you’re dealing with and I want to help you. Let me know the situation that you’re currently dealing with.

Let’s now look at phase number three, what to do after the meeting. The section really is about follow through. Many families lose here because they don’t take actions after the meeting. So, okay, phase three, after the meeting, and this is where a lot of families drop the ball because the meeting is over, they’re exhausted, they go home and they assume everything that was discussed is going to happen the way it was supposed to, but that’s not always the case. Things get forgotten. Plans change, and if you’re not following up, nobody else will advocate for your loved one. Here’s what you do after the meeting. First, get things in writing.

Before you leave the ICU or leave the hospital, or as soon as possible after the meeting, ask for a written summary what was discussed and what decisions were made. Say this. Thank you for the meeting today. To make sure we are all on the same page, can we get a written summary of the decisions and the next steps that were agreed upon? We want to make sure nothing falls through the cracks. This is not confrontational. This is professional and it protects you and your loved one. Action step number two, follow up within 24 hours.

The next day, call the ICU or if you’re there in person, ask to speak to the nurse or to the intensive care specialist and say, “Hi, I’m calling to follow up on yesterday’s family meeting. Can you confirm that the plan we discussed is being followed? Has anything changed? Are there any new developments?”

In the meantime, you should also have access to the medical records, of course. Like I said, you shouldn’t go into a family meeting without having access to the medical records. But this also shows the team that you are engaged, that you’re paying attention, and that you will not be an easy target. You should never be an easy target in a situation like that.

Next, document everything. Write down the date and time of the meeting, who was in the room, what was said, what was agreed on. Keep a log, because I can tell you from my extensive experience, they will keep all of that information. Someone will take notes and they will put it in the medical records. Because if something goes wrong later, if you think there’s disagreement, if a decision is made without your consent, or if the plan changes without your knowledge, that documentation is your evidence. I cannot tell you how many families have come to us after something has gone wrong. And the first thing we ask is, “Do you have any records of what is said?”

And most of the time they don’t because nobody told them to keep records.

So, I’m telling you now, keep records, document everything. I would go as far as recording. The meeting on your phone device or on your iPad, they don’t necessarily need to know that it is so much easier for you to go back and listen to a recording.

So, let’s do a quick recap of what we’ve covered so far because this is a lot of information to take in and I want to make sure you have it all. We talked about why family meetings are so difficult, the perceived power imbalance, the pressure tactics and the information gap.

We broke the family meeting into three phases before, during, and after, and I gave you specific strategies for each one. I gave you word for word scripts for three of the most common scenarios you will face. When they tell you your loved one is not improving and how to push for the real data. When they suggest withdrawing life support and how to buy yourself time and explore options, when they suggest transferring to LTAC and how to push back and explore alternatives, including intensivecareathome.com. And we talked about what to do after the meeting, getting things in writing, following up and documenting everything. And once again, I can’t stress enough.

Before all of this happens, you need to have access to the medical records and you need to have someone else look at your medical records, someone with the experience and the expertise like we do at intensivecarehotline.com. Now, we’re not done. We have more to cover.

We’re going to go even deeper. We’re going to talk about how to handle specific medical scenarios in family meetings, tracheostomy decisions, ventilation, weaning, and more. We’re going to do a live Q and A where you can ask me anything and we’re going to talk about when it’s time to bring in professional advocacy and exactly how to do that.

Also, if you haven’t subscribed to my YouTube channel, just do that right now, hit the subscribe bell and the notification bell and hit the like button and share the video with anyone who needs to know about this information. You don’t want to miss what’s coming next. And if you do need help today, right now, not next week today, go to intensivecarehotline.com. Call us there or send us an email to support@intensivecarehotline.com. We can help you prepare for your family meeting. We can review your loved one’s medical records. We can even represent you in the meeting itself. The link is in the description to intensivecarehotline.com and the phone numbers are on our website.

At intensivecarehotline.com, we are here for you. Now, let’s keep going and let’s look at the script cheat sheet.

What to say when the intensive care team says your loved one is not improving? You can say, “Can you be more specific? Which markers? What’s the trend over the last 48 to 72 hours?” What do you say if they say, “Withdraw life support suggested. We need at least 72 hours before any changes. We’d like to explore second opinions and we will not agree to any withdrawal of treatment decisions at this point in time because it’s our choice and our choice only.” Intensive care teams are very good to pretend they can do whatever they want. They are the master at that.

They can pretend they can do whatever they want until you push back. When you push back, the game is changing. When you ask the right questions, when you have someone on your side that understands intensive care inside out, you will see the dynamics change in your favor. So, don’t let them pretend they can do whatever they want.

Also, let’s move on. What do you say if they say, “We want to move your loved one to an LTAC or to a nursing home when a transfer is suggested?

This is for our audience in the U.S.” So, you ask, “What are the alternatives? Is intensivecareathome.com an option?” What do you say if the ICU team tells you that your loved one needs to stay in ICU for long periods of times?  Then you also ask, “What are the alternatives? Is intensivecareathome.com an option?”

What do you say after the meeting? Can we get a written summary of decisions and next steps? Now, I can see the viewers right now. I want to know from you what are your questions? Do you have any questions? What is your experience with family meetings in intensive care? I would really like to hear from you what your thoughts are. Type your comments, your experience, your questions into the chat pad, or you can connect with me live here on the StreamYard link. I’ve just posted the link in there if you want to talk to me directly. Now is your opportunity to talk to me directly if you want to.

But I really want to know from you, what’s your experience with family meetings in intensive care? Why are you here today? What are your biggest frustrations? What are your biggest challenges around family meetings in intensive care? I would really want to know from you. Leave your comments in the chat pad or connect with me live here on the StreamYard link.

While I’m waiting for your comments or for someone to connect, do not be intimidated by intensive care teams and go in with your head held high. Have a good posture, good body language. Never be intimidated. It is really important that you keep that in mind.

And always keep in mind that without having access to all medical records, they’re probably only telling you half of what is going on. They’re probably only telling you half of what’s going on. They’re probably deliberately withholding information from you, especially if you don’t have access to the medical records. Now, Nightbook says, “Hello, sir. My father now is in the ICU. Two weeks after cardiac arrest, he’s conscious and present. But today, they did a CT scan for the brain.” Hang on, I’ll just put that. “Today, they did a CT scan for the brain. He isn’t able to move his legs and hands.” Okay.

Nightbook, what is the CT scan saying? Have you seen the CT scan report? Right?

Other questions that you need to ask here in Nightbook is he still on any sedatives or opiates that still keep him asleep? Also with a cardiac arrest, has he had a hypoxic brain injury or an anoxic brain injury? How long was his downtime? How long did his heart stop for? How long did it take them to get a heartbeat back? Conscious and present, but today they did a CT scan for the brain. He isn’t able to move his hands and legs. He’s off sedatives now. How long has he been off sedatives? How long? Are we talking about hours? Are we talking about days? And like I said, has he had a hypoxic or an anoxic brain injury? It’s a good sign that he’s conscious and present. That’s a very good sign, right?

Also, two weeks after cardiac arrest, again, how long has he been off sedation for? Has it been few days? Has it been many days? Tell me more Nightbook. What’s the ICU team telling you about prognosis? “It was an out of hospital arrest to get less than 10 minutes to get the heart working again.”

Okay. Okay. Are they telling you that he has a hypoxic or an anoxic brain injury? What are they telling you? “He’s off to these two days of sedation.”

That’s not a very long time. That’s not a very long time, two days. Is he still on opiates such as morphine or fentanyl? Do you know? So, two questions. Is he still on morphine or fentanyl? And is he having a tracheostomy?

Those two questions would be important. Is he still ventilated? Very important questions, those two. “They haven’t confirmed a brain injury yet. Tomorrow, we will see the results and talk to the doctor.” Okay. That’s interesting that they haven’t confirmed a brain injury. Well, it’s interesting, but it’s a really important question you need to ask whether he has a brain injury or not. Again, is your father still ventilated? Is your father still ventilated? You can just type yes or no. “He has the breathing tube in, but he’s not depending on the machine to breathe, as they said.” So, he’s probably passing some spontaneous breathing trials, probably. Have they asked you for a tracheostomy?

What’s the next step with ventilation? If he’s been ventilated for two weeks, he should either be extubated now, i.e. have the breathing tube removed or he should have a tracheostomy. Have they talked about a tracheostomy?

Yes or no? Have they talked about a tracheostomy? Yes or no? Nightbook, have they talked about a tracheostomy? Yes or no? Or do you know? “No, they haven’t talked about a tracheostomy yet.” Okay. So, do you know what a tracheostomy is? Yes or no? Do you know what a tracheostomy is? Yes or no? Nightbook, do you know what a tracheostomy is? Yes or no? Okay. Also want to welcome John, John P. Who says, “Hi, Mr. Hutzel.” I don’t know, John, whether you have any questions.”

Okay. Okay, great, great. Okay, that’s good. A tracheostomy is a breathing tube. At the moment, your father would have the breathing tube in the mouth. 

A tracheostomy is a breathing tube that goes through the neck. It is much easier to tolerate, much easier to tolerate, and it gives your father a lot more comfort. Now, there’s two trajectories here now, Nightbook. So, after about two weeks, he should have either the breathing tube removed or he should have a tracheostomy. A lot of damage can be done long-term if someone has a breathing tube in their mouth for too long. They can get a ventilator associated pneumonia (VAP), the vocal cords could get damaged.

So, moving to a tracheostomy, if your father can’t have the breathing tube removed, should be the next natural step. I’ve made countless of videos about that Nightbook when to do a tracheostomy. Go on our website at intensivecarehotline.com and type in the search box when to do a tracheostomy and you’ll get a lot of information there.

Okay. I want to move on to John P. who says, “My mom is currently in ICU. She has been intubated with oxygen support. She presented to the ICU about 17 days ago with a pneumonia.” She presented the ICU with a pneumonia. Okay. She was treated with antibiotics about seven to 10 days. Okay. John, what’s your biggest challenge? What’s your biggest challenge?

She’s not improving. We also have some time. If you want to talk to me directly here, you can do so by clicking on the StreamYard link and you can talk to me directly. That might get the questions answered quicker. So, John, you’re saying she was treated with antibiotics with about seven to 10 days.

What is your biggest challenge? What is your biggest challenge? Okay, she’s been off sedation three days. I presume hasn’t. You say hasn’t taken up it, but you’re probably saying hasn’t woken up yet. Okay, got it. So, few things there, John. What sedatives was she on? What opiates was she on? Yeah, your concern is her not waking up. What sedatives was she on? What opioids was she on? Are her liver working? Are her kidneys working? Because if liver and kidneys are not working, that takes a lot longer for sedatives and opiates to get out of the body system. Again, that brings me back. Do you have access to the medical records? Have you asked them about access to medical records? Have you asked them about liver and kidney function?

That’s one thing. Ketamine, propofol and fentanyl. That’s a lot. That’s a lot.

Okay. So, she’s off all of that. That’s good. Now, let’s just say kidney and liver are working. And let’s just say the opioids and the sedatives have been flushed out of the body and she’s still not waking up.

That could mean that your mom simply is tired and critically ill and she simply needs time to recover. But that leads me to the next question. Is your mom, has the infection been cleared? Right? Has the infection been cleared? Is she still on antibiotics? Is she still on antivirals or antifungal medication? So, if the pneumonia has been cleared and they’ve stopped antibiotics or antivirals or antifungals, if the infection has been cleared, if she is off sedation of sedatives of opiates, she should slowly but surely wake up. Now, let’s just say she’s not waking up despite of everything that I said. She’s off sedation, she’s off opiates, they cleared the infection.

Let’s just say she’s still not waking up, then your next question needs to be, has there been a neurological event? So, when someone is in an induced coma, for example, and God forbid they sustain a stroke, they may not have found that out. So, one of the things that should be happening here is if she’s not waking up, they might need a neurological… Right, right. So, the infection has been eliminated, normal antibiotics. Okay, yeah. So, then the next step here is, John, to ask them for a neurological consult. What that means is, has she sustained a stroke while she was sedated? Has she had seizures while she was sedated? Is there something else going on in the brain?

Does she have meningitis, encephalitis? I don’t want to dramatize here, but I’ve seen these sorts of situations. So, your question here is, has there been a neurological event? Okay, head CAT scan and EEG (Electroencephalograph). Okay, good, good. Okay. Okay. Then I would say, John, you got to give your mom some time. Waking up after an induced coma is like switching on the light with a dimmer, not with a switch. Let me say that again. Waking up after an induced coma is like switching on the light with a dimmer, not with a switch. How long ago was the CT scan of the head and the EEG? How long ago was that? In the last few days or on admission? Vitals, good and blood pressure. Good, good, good. How long ago was the CT scan and EEG?

How long ago? Was it at the beginning or was it just in the last few days? So, vitals, good head CT scan two days ago. Okay. Okay, good, good, good, good, good. So, I would say from my experience, John, she just needs time. 

She just needs time to wake up. We all want to put timelines on things. And we all think, done yesterday. Okay, good, good, good. That’s actually really positive that cerebral was done yesterday. So, all the diagnostics were there in the last few days. It’s actually really positive. EEG yesterday. Okay, good, good. So, they’ve ruled that out. Okay. I would say, John, be patient. Be patient. Talk to your mom. Hold her hand. Play music she likes. Maybe hang some pictures around her family pictures. Just create as much normality as possible and give it some time.

Patients don’t wake up in normal timeline as per textbook often. But do you know if kidneys and liver are working? Do you know that? Have you asked for that? Are kidneys and liver working? If you haven’t asked if kidneys and liver are working, you need to ask for that. I would also strongly recommend that you get access to the medical records. Strongly recommend that. The other information here that would be of value is what ventilator settings is she on?

I’ve talked about a tracheostomy. Okay. Kidney is okay, urination. Good. Okay.

What about the liver? Is the liver working? Do you know if the liver is working? And why are they talking about a tracheostomy? Why? Are they talking about a tracheostomy because she can’t be weaned off the ventilator? 

Probably because she’s not awake. I can see why they would be talking about a tracheostomy. Okay. Liver’s working. Okay, great. Great. Okay. Look, then the next question here is, again, why is she not waking up? I believe she’s simply not ready because she’s simply crooked. And then the next question is, what are the ventilator settings? And is it realistic that she can be weaned off the ventilator and extubated in the next few days?

If not, then she might need a tracheostomy. Not awake and not breathing too great yet. Look, she may need a tracheostomy, especially since it’s two weeks now. She may need a tracheostomy. But that sounds to me like it would be something that would be temporarily and she can be weaned off that tracheostomy eventually. Right. Ventilator setting is from 40% to 50%. All right. Right. Okay. Oh, it’s going up. So, then the question here is, is the pneumonia not cleared? Why would her oxygen demand go up if the pneumonia has been cleared? Find out if there’s a recurring infection. Or is she potentially fluid overloaded, too many fluids on her chest that compromise respiratory function? Now, we are at the hour mark now.

I do need to wrap this up as I have other things to go to. I do want to thank for your participation. I do want to thank your support for your support. Share this video with your friends and families. Go and check out intensivecarehotline.com and intensivecareathome.com.

I’ll do this YouTube live again next week at the same time.

Go and tune in. Thank you so much again, and I will talk to you soon.

Take care for now.

I have worked in critical care nursing for 25 years in 3 different countries where I worked as a nurse manager for over 5 years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews. And because our advice is absolutely life-changing.

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 that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

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

Take care for now.

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