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 one of my clients and the question last week was
My sister is in ICU on a balloon pump and ventilated after cardiac surgery! The ICU doctors want to stop treatment
against our wishes and let her die, what should we do? (PART 9)
You can check out last week’s episode by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question from one of my clients Emma, which are excerpts from 1:1 phone and email counselling and consulting sessions with me and the question this week is
My sister is in ICU on a balloon pump and ventilated after cardiac surgery! The ICU doctors want to
stop treatment against our wishes and let her die, what should we do? (PART 10)
You can also access PART1, PART2, PART 3, PART 4, PART 5, PART 6, PART 7, PART 8 and PART 9 by clicking on the links
In this series of 1:1 phone and email consulting and advocacy sessions with my client Emma you’ll get real in-depth knowledge about cardiac failure) in Intensive Care, how it works, the treatment and therapy options, how to wean somebody off the ventilator and most importantly, you’ll discover how to not take “no” for an answer.
You’ll witness how I can lead Emma in going from the Intensive Care team trying to coerce her and her family to agree to a “withdrawal of treatment” as being “in the best interest” for her sister to challenge that and the Intensive Care team having to do everything within their power to safe her sister’s life and turning the dynamics upside down in Emma’s favour.
That’s what happens when you have the right advice from a professional who knows Intensive Care inside out and who knows how to manage the dynamics
and who can take the fear away of being intimidated by the Intensive Care team!
Enjoy this consulting and advocacy session!
Emma: Hello, Patrik.
Patrik: Hi, Emma. How are you?
Emma: Oh. I’m kinda nervous because of what
they told me overnight. I haven’t went up this morning.
Patrik: Say again. You haven’t what?
Emma: Well, I haven’t gone to the hospital this morning yet. I found that information out at 4:00 this morning.
Patrik: At 4:00 AM, right. Did they call you or how did you
find out?
Emma: Well, I called because I took a break because I’ve been there continuously, so last night my brother-in-law relieved me and I took a break. But I still call and check on her.
Patrik: Okay. What are they saying for today? Are they wanting to take her off the ventilator? Is that still the plan?
Emma: Well, that was it yesterday, but I was gonna give the nurse … It’s like 8:44. The nurse told me they’re busy around 8:00, so I was gonna wait til like 9:00, 9:30 this morning to call and check, and I’m gonna go up there later on today.
Patrik: Okay. Okay. So you don’t know what the plan for today is yet.
Emma: Not yet.
Patrik: Right. Look, I do believe that … So there’s two things. On the one hand, I don’t like that they had to start the epinephrine. I don’t
like that but, at the same time, you said she has been on the dialysis machine continuously. She never had a break really, did she?
Emma: She didn’t.
Patrik: Right. Right. So they’ve basically been removing fluids for the last week.
Emma: Yes. All this time.
Patrik: Okay. So, look, as I said, I don’t like that they started the epinephrine(Adrenaline), but it could well be that they’ve taken off too much fluid.
So that could be one of the reasons why they’ve started the epinephrine(Adrenaline). The other reason could be that because they can’t wean the vasopressin. The epinephrine will make it more likely that the vasopressin will come off. That could be another reason. But another reason could also be that your sister’s heart is weakening.
So, as I said in the email, the most important thing is to keep the lungs dry.
That’s the most important thing at the moment. And one of the reasons… They can keep the lungs dry at the moment by removing fluids, but by also making sure the heart can pump blood around. That’s why they’re using the vasopressin, the norepinephrine, and the epinephrine, and the dobutamine(=inotropes/vasopressors). So it’s all working together to achieve that, to keep the lungs dry at the moment.
So the question really is, can they continue with their plan today to take her off the ventilator? That would be the question, right? So it’s probably best if you-
Emma: Okay.
Patrik: It’s probably best if you get an answer from them, and also-
Emma: Okay.
Patrik: … but also not be discouraged if they can’t. With the unit of blood she had, is she bleeding? Do you know whether she’s
bleeding?
Emma: They haven’t said anything about her bleeding. They just said that they gave it to add volume. But they didn’t … I’ll ask them. They didn’t say anything about bleeding.
Patrik: Okay. Okay. Do you know how low her red blood cells are? Do you have any numbers?
Emma: I’ll have to … I’ll ask them. I didn’t ask.
Patrik: Okay. That’s okay. Do you know whether she’s had any blood thinning medicine over the last week?
Emma: Well, she’s on heparin.
Patrik: She’s on heparin,
so-
Emma: They have her hooked to heparin.
Patrik: Yeah. She would be on heparin. And do you know whether she’s on a heparin infusion?
Emma: It is.
Patrik: Right.
Emma: It’s connected to that Dialysis machine.
Patrik: Right. Okay, yeah, it would be. And that could be one of the reasons why. She may lose a little bit of blood there, and that’s why they have to replace it with a blood transfusion. Do you know whether she’s had more blood transfusions over the last week or is this the first time?
Emma: With this week here, this is the first time-
Patrik: First time. Okay. That’s fine.
Emma: … that she had it. But the week prior to she had.
Patrik: Okay. Okay. So the question really is, why have they started the
epinephrine(Adrenaline)? As I said, there could be three reasons why they started the epi. Again, number one is they want to wean off the vasopressin.
That’s number one. Number two, she’s too dry and they … Basically what the epinephrine is doing is it’s squeezing her veins and her arteries. As I said, I don’t want to get too medical there. Or number three, the heart is getting weaker. That could be another reason. So you may want to
ask-
Emma: Okay.
Patrik: You may want to ask that question. The other thing … They didn’t mention anything that they’ve done an echo since you’ve left the hospital yesterday.
Emma: They didn’t. They didn’t mention it. I’ll ask them again. But what … She said that because her
blood pressure had dropped so low, so…
Patrik: Yeah, yeah. Yeah, yeah. I get that. And the blood pressure has dropped low most likely because she’s dry, most likely because they’ve taken off too many fluids too quickly. That’s the most likely reason from your email as well.
But …
Emma: Okay.
Patrik: That’s why I’m asking. It could well be that they’ve done an echo/ultrasound of the heart and they’ve seen, “Oh, the heart’s not coping. We need to start the epi.” But
it’s a question you need to ask, why they started the epi, and are they still going ahead with taking her off the ventilator today? Those would be the most important questions at the moment. And also, do you know how low the blood pressure went?
Emma: I’ll find out. She didn’t tell me.
Patrik: Right. And if you can get some blood results, that would probably be helpful as well. See how you go. See what they say. See what they say. So no reason-
Emma: Okay.
Patrik: No reason to panic. It’s just …
Emma: Oh, I was just gonna ask you that. Whew!
Patrik: Say again?
Emma: I was just about to ask you, is it time to panic yet?
Patrik: No. Look, panic is always the wrong approach in intensive care. It’s always the wrong approach. Look, your sister is … She has been improving all week and it looks like at the moment she’s hitting a bit of a bottleneck. But no matter what the reason for the epinephrine(Adrenaline) is, panic is always the wrong approach. It’s always the wrong approach. I know, again, it’s easier said than done, but they’re doing … One way or another, it doesn’t
matter what the reason is why they started it, I still do believe they are doing all the right things.
They’re definitely doing all the right things. The question is, can they take her off the ventilator today? That would be the question.
Emma: Okay. Okay.
Patrik: And if they can’t take her off
the ventilator today, then the question also will be, will they keep your sister awake, and can she tolerate being awake whilst on the breathing tube?
Emma: Okay.
Patrik: How did that go yesterday? Was she … Do you think she was able to tolerate it?
Emma: If they take it off?
Patrik: No, I-
Emma: Because she has been. Like yesterday … I’m sorry, go ahead.
Patrik: No, no, no. No, no, all I was asking is, do you feel like … Because she was off sedation, do you feel like she could tolerate the breathing tube without sedation?
Emma: Yes.
Patrik: Right.
Emma: Yes. She has been doing that.
Patrik: Okay. Okay. Because the more awake she can be, the better it is. The question is, can she tolerate that breathing tube for much longer? That’s going to be the question.
Emma: Okay.
Patrik: If you want to, as I said, very happy that when you’re there, I would be very happy to talk to the nurse or whoever is there directly. If
you can make a phone call, I would be very happy, but see how you go. See how you go.
Emma: Okay. Okay. Okay.
Patrik: Does that … Is that-
Emma: Okay.
Patrik: Is that clear about what you need to look
for, what you need to ask?
Emma: Yes, it is.
Recommended:
Patrik: Yeah. Okay.
Emma: Yes.
Patrik: Okay. No, no, that’s good. That’s good. Ask and, yeah, see what they say.
Emma: Okay.
Patrik: Alright?
Emma: Alrighty.
Patrik: So you’re not-
Emma: Thank you.
Patrik: You’re very welcome. You’re not in the hospital at the moment.
Emma: No, I’m at my
apartment.
Patrik: Right. Right. Okay. Yeah, okay. Look, see how you go, and-
Emma: I was starting to freak out.
Patrik: No, no. Don’t freak out. No, no. No, no. Look, it’s touch and go, don’t get me wrong. But again, as I said, take one day at the time, and sometimes it’s
even one hour at the time. It’s … Those things happen. It’s often two steps forward, one step back.
Emma: Okay. Okay.
Patrik: Okay? I’ll wait to hear from you, then.
Emma: Okay, okay. Thank you so much.
Patrik: Oh, you’re very welcome. Take care.
Emma: Uh huh. Bye bye.
Patrik: Take care. Bye bye.
