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 in last week’s episode was
The ICU Doctors said my mother’s survival is unlikely! Is there any hope?
You can check out last week’s question by clicking
on the link here.
In this week’s two-part episode of “YOUR QUESTIONS ANSWERED“, I want to answer the questions from one my clients PAULA as part of my 1:1 consulting and advocacy service!
Paula has her father transferred in the Intensive Care due to a torn aorta. In the end, her father had undergone an emergency tracheostomy and open heart surgery, a growing concern is that her father is unable to come-off sedation due to behavioural changes during waking
moments.
My father has a tracheostomy and the ICU doctors are planning LTAC!
How can I keep him in ICU?
Paula: Hello.
Patrik: Hi, is this Paula?
Paula: Yes, this is Paula.
Patrik: Paula, it’s Patrik here from Intensive Care Hotline. How are
you?
Paula: I’m okay.
Patrik: I just got your message. I was on another call when you phoned, so I’ve got about 15 minutes now if you have time. Excuse me, I’ve just got to clear my throat.
So your dad is in ICU and now, they have done a tracheostomy already, have they?
Paula: Right, he’s sedated. He was on a ventilator, now they’ve trached him.
They did a pacemaker. He’s not taking any IV medication anymore except
the sedation. And they say that they can’t un-sedate him because he gets apprehensive as they start to wake him up.
Patrik: Sorry, can you repeat that? Why can’t they stop sedate him? Why is that?
Paula: They say that as he’s starting to wake up he gets apprehensive, and he starts to breathe really heavy-
Patrik: Okay.
Paula: -so they sedate him again right away.
Related information:
Patrik: Okay, how many days has your dad been, I see just over two weeks.
Paula: Just over two weeks, yes.
Patrik: Right. And they did the tracheostomy when? Yesterday?
Paula: Two days ago.
Patrik: So Saturday?
Paula: No, it was like four days ago.
Patrik: Right.
Paula: It was right after Labor
Day.
Patrik: Okay. And in your email you’re saying your dad had surgery for a torn, is it an aorta or an aroma. You say aroma … but it must be an aorta. Can you just fill me in?
Paula: It was the aorta.
Patrik: Okay, okay.
Paula: It was his aorta.
Patrik: And what, why couldn’t he get off the ventilator in the first place? Were there any
complications?
Paula: Every time they would try to wake him up, or he would cough, he would bite on the ventilator tubing.
Patrik: Okay.
Paula: And he would cut off the airways.
Patrik: Right, okay. Was
the surgery elective or emergency?
Paula: It was emergency.
Patrik: It was emergency. So they basically rushed your dad to hospital, and they operated on him fairly quickly?
Find more information about open heart surgery:
Paula:
Yes.
Patrik: Right.
Paula: He was in the emergency room like 4:00 in the morning, by 9:00 he was on a surgery table.
Patrik: Okay, and what happened? Why did he go to the emergency room?
Because he had water in his
lungs?
Paula: Well the night before, he gone to bed, he said that his throat hurt. And he said his back hurt, and he was in bed, and he didn’t get out of bed. And then at 4:00 in the morning, because I live with him, I heard … his light was on, and I heard like a noise. I went in to see where he was, and he was like sitting on the edge of the bed with his feet on the floor and we was laying down. And I asked him what was
wrong. I said, “Can you breathe?” He said, “Yeah.”
And then I tried to get him up, but he couldn’t like help himself up. And then he said he was hot, and my father is always cold. So I called 911. And then they took him to the emergency room, and then they saw with an X-ray that the aorta was ripped, torn.
Hello? Hello? Hello?
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Paula: Hello.
Patrik: Hi Paula, it’s Patrik again, can you hear me?
Paula: Yes, I can hear you, we got disconnected.
Patrik: Right, I could hear you perfectly fine but then … I could hear you, you were asking whether I could hear you, then I thought I’ll hang up and try again.
Anyway, I can hear you perfectly fine.
Okay. So, he would have lost a lot of blood before, and probably during surgery as well.
Paula: Oh yes, definitely. They had given him 10 pints before the surgery.
Patrik: Okay, I see, I see, okay. Has he gone into renal failure as well … kidney failure?
Paula: Renal fail … no he has one kidney and it happens to be working, but the nephrologist is amazed at how well his kidney is working.
Patrik: Okay, because that is one of the major side effects of an aortic dissection … going into kidney failure afterwards. Well, that’s
good that it didn’t happen. You are the medical power of attorney?
Paula: That’s correct.
Patrik: Did you have second thoughts about consenting to a tracheostomy?
Paula: For the trach, yes I did. They kept saying that he can’t breathe, and every time he would cough, he would get bright red, and he would choke. He would chew down on the breathing tube, and then his pressure would go crazy. Now, he’s not on any IV medication at all, and he’s taking an oral pill for his blood pressure, which they say seems to be helping him.
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Patrik: Okay, what’s his-
Paula: Now, they want to push him out.
Patrik: What’s his blood pressure like? High or low?
Paula: He has high blood pressure. For him right now, his
blood pressure is running like 132/90 with the medication. Right after the surgery, it was very low. It took them a long time to get it up.
Patrik: Right. Yeah, yeah. Especially with all the bleeding. Do you know what he’s getting at the moment to contain his blood pressure?
Paula: I wrote it down. It’s something … I wrote it
down.
Patrik: I’ll mention a few. Metoprolol?
Paula: It starts with an A, I think.
Patrik: With an A?
Paula: Yeah. I had them spell it for me.
Patrik: It’s not adrenaline?
Paula: No.
Patrik:
Right.
Paula: I wrote it down. What did I do with it? No, it’s something with a P-acholine or something like that.
Patrik: Not aminophylline.
Paula: No.
Patrik: No….
Paula: No.
Patrik: Okay. Well, that’s okay. Don’t worry too much about it. Don’t worry about it. What’s the bottom line probably is that with the tracheostomy.. the minute …
based on the tracheostomy … they probably started talking about LTAC (Long-term acute care). Is that correct?
Paula: Oh yes. Oh yes. Even before they did that. The week … even the week …
my father was four days out of surgery and they were already talking about a long-term healthcare and he hadn’t even woken up
yet.
Patrik: Do you know much about LTAC? Have you done any research? Do you know much about it?
Paula: I don’t know much about it. I do know they say they’re going to send him there to help him get off the trach. It’s supposed to help him … they wean him …
that’s what they
say.
Related information and article:
Patrik: Right. Have they given you any time frames?
Paula: For him to get off the
trach?
Patrik: That, and, or LTAC. Either getting off the trach and, or LTAC. Have they given you any time frame?
Paula: No. They haven’t given us any time frame.
Patrik: I’ll tell you what I can see, Paula, so far.
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Paula: Okay.
Patrik: Let me ask one more question. Do you know what sedation he’s getting?
Do you know what they use to put him asleep?
Paula: Oh yeah. They’re giving him propofol.
Patrik: Propofol. Okay. He has
been on propofol all the way along, or did they change that? Do you know?
Paula: They had tried to take him off and put him on something else that was not as strong, and then when he woke up he would get apprehensive, and at times …
in between that … at times, they had given him morphine, too. They said that his heart rate would just go crazy.
Patrik: Do you feel that when they put your dad asleep, do you feel he’s comfortable, at least? Is that your impression?
Paula: Yes. He looks comfortable. Yes. That’s why they say they put him to sleep, because he looks like he’s uncomfortable. When he’s sleeping, he does look comfortable. But, he was awake a little bit … before they did … and they did a feeding tube, too.
Before they did the feeding tube, when they would wake him, he kind of looked like he could hear us. We were talking to him and he would acknowledge us.
Patrik: Have they done a CAT scan of the brain?
Paula: No. For some reason, they haven’t done that yet. They said because he’s not awake. My brother and I both insist that they do that, because
that really determines a lot of things.
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Patrik: Absolutely. I tell you what I can see from my experience. Number one, one of the main reasons patients have a
tracheostomy is to wake them up and not use sedation like propofol. This is always the situations that you’re describing at the moment, that patients don’t wake up properly. That always does happen.
I can tell you that with a leaking aorta and the emergency surgery, I would say …
you know, I’ve seen a fair few of those type of surgeries over the years. It’s one of the main side effects …
people don’t wake up, and that’s even worse with increasing age. It’s a situation that I have seen before. That’s number one.
That doesn’t eliminate the fact that patients who have a tracheostomy should be woken up as quickly as possible. That’s the whole purpose of a tracheostomy, right?
Paula: Right. That’s what I thought, too.
Patrik: Absolutely. So, the whole purpose of a tracheostomy is, generally speaking, making patients more comfortable if they can’t come off the ventilator straight away. May I ask, do you think your dad is more
comfortable with the tracheostomy compared to the breathing tube in his mouth?
Paula: Yes.
Patrik: So, then if patients don’t wake up after they’ve had a tracheostomy, and if they are agitated, the next step really is to do a CAT scan of the brain. The reason for that is simply, your dad could have, in theory, had a stroke, right?
Paula: I know.
Patrik: They need to rule that out. They need to rule that out.
Paula: Right.
Patrik: When was the last time when you felt your dad is acknowledging you, and your dad can see you, and your dad is basically aware of what’s going on?
When was the last time you would say that was the case?
Paula: Well,
we just had this big hurricane here, so we weren’t able to go to the hospital for the weekend, but I would feel Wednesday night. I could swear that when I was there, he was semi-awake and I was talking to him, and I could swear that he was kind of following my voice with his eyes. It could be in my imagination, but I swear he blew me a kiss.
Patrik: Okay. Good. Good.
Paula: It could have been my imagination.
“Thank you very much for being a part of the previous series of 1:1 consulting and advocacy sessions. We
hope you will find these new upcoming episodes informative and empowering.
Kind Regards
Patrik
