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 first question from Paula in last week’s episode was
My Daughter Stops Breathing Frequently in ICU! Does She Need a Tracheostomy?
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 PETER as part of my 1:1 consulting and advocacy service!
Peter has his father transferred in the Intensive Care due to stroke. His father eventually had fluid in his lungs due to a persisting heart problem.
My father cannot wean off the ventilator in the ICU due to pneumonia and stroke, does he need less sedation?
Patrik: Intensive care hotline Patrik
speaking.
Peter: Hi this is Peter. I emailed you about my dad in ICU and I booked some 1:1 consulting sessions with you.
Patrik: Yes. Yes. I send
you a voice message an hour ago or something like that to confirm.
Peter: Yeah. I saw this, thank you for responding to me.
Patrik: Your welcome.
Peter: I know you understand the situation. Um, yeah, my… my… dad had um, do you have some time now?
Patrik: Yeah. Yeah. I’ve got up to an hour. You booked an hour, so I’ll make sure you get the full hour of course!
Peter: Okay. Um, would you like me to give you the back drop sir?
Patrik: Um, you’ve given me some of the facts already in your email. What’s your biggest concern at the moment is it that your Dad is not
getting off the ventilator?
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Peter: My biggest concern as we go forward… We’ve had two
days of good vibes. The last two days have been good vibes. Um, he’s responding. Well, they’re taking him off the medication. He went for four hours off the ventilator two days ago. He went four and half hour yesterday pretty much on his own off
ventilation. So we’ve had two days before where we felt pretty good. We’re too scared to go on. I know that it’s coming to a point where. He’s got to improve to the point where he can breathe on his own to take the ventilator off. I’m just I’m just scared to death for my Dad.
Patrik: OK, how old is your Dad?
Peter: My dad is seventy-five, right? And he
probably still has fluids on the lungs (congested lungs).
Patrik: Does he have an atrial fibrillation? Have you heard of that?
Peter: Yeah, the doctors have said that yeah, because he because he probably had a heart attack.
Patrik: Right, right! So here’s what I can see Peter from a bigger picture perspective. So I totally understand how scared you must feel because you haven’t seen this before. I would imagine this is the very first time you are in you are
in the situation like that. Is that correct?
Peter: Yes, right.
Patrik: So are you the medical power of attorney for your dad?
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Peter: I am right?
Patrik: Okay. So, so therefore you know, the burden on you is pretty big. I understand
that. To put things in perspective, what’s really important and to give your perspective around this really scary situation now giving you a little bit about little bit of background. So that you understand where I’m operating from because I worked in intensive care for nearly 20 years, right? I’m an intensive care nurse by background. I worked in this environment for nearly 20 years. Now what you’re describing there is a situation that I’ve seen I don’t know hundreds of times maybe even
thousands of times or so. You know to me this is bread and butter, but I also know how scary this is for you and your family, right? So the AF (Atrial Fibrillation) has probably led to a stroke the AF is also leading to your dad having fluid on the lungs (congested lungs) are
making it difficult for your dad to come off the ventilator, right? Yes, when you’re saying you had good vibes to the responses you are getting from your dad? And what’s the vibe you are getting from the doctors and the nurses? What’s the vibe you’re
getting from them?
Peter: Three days ago it was doom and gloom and in the last two days it kind of gives me the vibe that they have hope.
Patrik: Okay, good, good!
Peter: Without, without them saying so.
Find more information
about positivity in the ICU:
Patrik: Yes, yes, and they wouldn’t have said so, but you’ve got to gauge their response, you know, it’s not so much what people say, pay attention to what they do and if you feel like they’re giving you a positive vibe that’s good and they would never, never ever in a million years would they say to you “ah we’re going to cure your Dad. He’ll be out of our ICU alive in no time.” They would never
say that never ever right because you know, you can you could sue them or you could do all sorts of things, but they will never say that to you but we obviously have to look at the actions very closely not so much at their words. The other thing that’s really important to know, five days in intensive care in a situation like this is not a long time, it’s not a long time. So for you I know this feels like an eternity and you know, because you don’t know what the outcome is going to be, you know,
you must be in a very scary place. I understand that. What’s also important to know is two things number one, nobody has a crystal ball, but number two more than 90% of patients in intensive care leave intensive care alive. Okay, let me say that again because it’s very important more than 90% of all patients in intensive care leave intensive care alive. So therefore, the question that you should be asking to yourself as well as to the doctors is, “Why should your Dad not be in that 90 percent
bracket?” And even though it’s scary for you, I can’t see any reason why your Dad can’t leave intensive care alive. Yes, you have some obstacles to overcome, but there is no reason why you can’t overcome those obstacles!
Peter: Right now the pulmonary doctors are in charge of his medical needs and then the cardiologists have come in and you know and basically told us, you know their apprehensions.
Patrik: Right!
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Peter: Um, basically, basically, you know, hey, he’s going to have problems. Even after he if he does come out of the induced coma and the pneumonia is taken care of, but you know they are telling is that complications are to be expected. We understand that.
Patrik: Right.
Peter: I’m not scared about that as I am scared about the point of him not being able to breathe.
Patrik: Yes, and that is that is very scary. You know, the reality is that the ventilator is considered life support. Okay, and if you can’t come off the ventilator, he will need life support. Now you might have
mentioned, you might have heard me saying that in my voice message to you earlier that he may need a tracheostomy. Do you know what I mean by that? Have you heard of the term tracheostomy?
Peter: Yeah, I YouTubed
it.
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Patrik: Yeah, right. So it’s too early to say whether he will or he won’t need a tracheostomy to me. I tell you what, I think needs to happen
with the information that you’ve shared. Number one. Your dad probably is in atrial fibrillation (AF). Do you know where that’s been long-standing AF or is that new, you know?
Peter: Um, can you repeat that?
Patrik: Your dad is in AF also known as atrial fibrillation or afib, you mentioned that earlier. Do you remember that?
Peter: Oh, oh with his heart.
Patrik: Yes, with the heart.
Peter: Yes. Yes. Well, the stroke, he had the stroke. And with the stroke, he lost the ability to hold any fluids down. Yes. He was throwing up. Um, and they think that he had the stroke. He had a heart
attack.
Patrik: Yes. Yes. Okay.
Find more information about tracheostomy:
Peter: They did say that. Yes.
Patrik: So I tell you a number of things that need to happen from here. Number one. He’s probably in an irregular heart rhythm. That’s probably what’s caused the stroke in the first place and then potentially the heart attack. In the ideal world he needs to go back into a regular heart rhythm because that’ll keep the fluids of the lungs out. I don’t want to
get too medical here. But you know, that’s what I can see. Um, okay the heart needs to recover if possible at all. In order for your dad to get off the ventilator most likely but he will also need to come off the sedation. So there’s a number of things that need to come into play. So the heart
needs to recover, number two, your Dad will need to be weaned off the ventilator and there are certain steps, they will need to go through. When we come off this call I will send you an article around how to wean a patient off a ventilator and the breathing
tube or endotracheal tube now if that fails, god forbid, he could potentially need a tracheostomy, but they need to work on getting him off the ventilator and the breathing tube/endotracheal tube in the first place. That’s what they need to aim for. Okay?
Peter: Okay, right. They were saying that, they were saying that his blood pressure was pretty good today.
Patrik: Okay, that’s good.
Peter: The nurse was telling us, you know, what they ideally would like to see and he was still a little high on that. Um, you know, I’m just wondering about the care that we as family should be having for him? I mean, we’ve been very positive for him and asking him to fight for us and I told him, I told the doctor I says, you know, he’s fighting now we need
you to fight for him.
Patrik: Yes.
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Peter: And he kind of looked at me, like “what?”. I don’t know but you know, it’s kind of corny. Yeah, but that’s what I had said. And you know, so I know my dad’s fighting but I can also I’ve seen him scared and um, you know, so you
know, he’s willing to do what it takes.
Patrik: Yeah. No, that’s good. That’s good. That’s a good attitude to have. You see staying positive is often half of the battle. And even though nobody has a crystal ball and your Dad could also die. You never know. I am a big proponent of staying positive because even, if you even if the worst-case scenario comes true, you’re still better off staying positive. Some people don’t
recognize that as valid, but I think staying positive is really important no matter the outcome. In terms of you know, you’re asking what care should you expect? I tell you what we do with the next step. I send you some articles around, you know, how to wean somebody off the ventilator, you know, that will give you some indication and ideas. I also send you an article how to get somebody out of a coma all of that, right? What I’ve also done. Sorry. I’ve also added you on to our free email newsletter. Where we basically publish case studies, you know, how we help families in Intensive Care and you know. You get case studies in your inbox and you know, just by reading them you, you will learn a lot about you know,
intensive care and how it applies to your situation or to your dad’s situation. If you feel like you want me to talk to the doctors with you, I offer all of that as part of the consulting and advocacy service, but I can also offer it to you personally or other family members like a
one-and-one Consulting service helping you asking the right questions to the doctors and all of that so that you can get best care and treatment. That’s part of what I do.
Peter: Okay. I have to consider if I need you to talk to the doctors or not. I mean I am I first of all I think that you’re doing a great thing here because I’m pretty lonely with this thing and just having this session is very
helpful.
Find more information about weaning ventilator:
Patrik: Right
Peter: I don’t have that much help outside you know, I really appreciate your time and you offering this to people.
Patrik: Your welcome.
Peter: And you know, it’s been, it’s been like a roller coaster up and down.
Patrik: Absolutely.
Peter: And you know, there’s several family members really working hard at this and who came to managing this situation with me as much as we can.
Patrik: Absolutely.
Peter: So, you know, maybe you know my brothers and I can pull our resources and you know, you know, see how more 1:1 consulting might help us all as a
family.
Patrik: Yeah. Yeah. And also, you know, right, also if you for example had a meeting with the doctors and you wanted me to be there over the phone again, I’m very happy to be there with you. And you know setting you up with the right questions, but I can also ask questions to make sure they are doing all the right things. But what I’ll do next is I will send you an article and the video around, you know, how to wean
somebody off the ventilator. I will send you an article and a video around how to wake somebody up from an induced coma and the other thing that I needed to mention is, take one day at the time, your goal at
this stage is to get your dad through the next 24 hours. One of the biggest frustrations for families is that they are looking too far ahead. You know your goal at the moment during a critical illness, your goal is get through the next 24 hours. Make sure your Dad is still there tomorrow! Take baby steps, take baby steps.
Peter: Okay, baby steps.
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Patrik: And also not being discouraged by any setbacks because they might come.
Peter: How, how concerned should I be? This is the one thing today that bugged me. Um, and I will take time but the one thing that bugged me is that the suction thing when his face is turning purple, basically because he has that
fluid.
Patrik: Yeah. Yeah…
Peter: That really frustrates me.
Patrik: Okay, ask them. I’ll tell you what you should be doing. Ask them whether they are pre- oxygenating him before suctioning. Basically what they should be doing, when they suction him, they should be giving him a hundred
percent of oxygen before they suction him. And what I’ll do is when I sent you this email sent this to you so you can ask them because that might solve the problem. You know, it often depends… the nurse who might be looking after your Dad might not be very experienced. You know, I don’t know who you’re dealing with at the end of the day, but I think you… a question that you should be asking them around the suctioning. And that will get you some leverage and they might be able to prevent that
just by giving him one hundred percent of oxygen before they suction him.
Peter: Yeah, because what he did today is he has the nurse alarm, he can reach for it and I handed it to him and he pushed the nurse alarm and then almost um ten seconds later, his face started to turn purple, right, you know, so then I went and got the nurse and he cleared it up and so right at that point, but then then the doctor came in and he put his
stethoscope to his chest and heard some gurgling for then they removed remove the fluid.
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Patrik: Right, right.
Peter: It seemed like he was unnecessarily suffering with the suctioning. They said that he was able to breathe but I can’t understand why he turned purple.
Patrik: Yeah, okay. He might have turned purple because number one he might have had some secretions on his chest that needed suctioning or number two, he might have turned purple because they were suctioning him but weren’t giving
him enough oxygen during the procedure or number three, he might have started coughing during all of this. And again, he was suffering from lack of oxygen or it could have been all of that! But in terms of your concern… you see the problem is, you see a lot of things that you’ve never seen before and don’t get me wrong. I’m desensitized to a degree because you know, I’ve seen this over and over again…
Peter: I
understand
Patrik: Right, I’m desensitized to a degree, but if your concern is his purple face and sort of not getting enough oxygen to the brain if that’s your concern, I can almost eliminate that concern because your Dad is in a controlled environment. And they have three minutes to give him oxygen and they can manage that within three minutes. I have no concern there. So I can eliminate that concern because you know, the
staff that are around him will know how to handle this, if they don’t, I don’t even want to go there but, you know given that things in an ICU are mainly controlled and they will know what to do, but it’s not nice not nice.
Peter: No and that’s the way when I watched ‘extubating’. I think that’s how you pronounce it ‘extubating’…
Patrik: Yes.
Peter: And when they were taking the tube out of patients their faces turned red also.
Patrik: Yes.
Peter: So I’m
very tired tonight. I thought I was going to have a good night, but it’s going to be a long night. Probably again why I crashed out last night.
Patrik: That’s why you need to look after yourself. That’s really important. That’s really important. Okay, Peter, what I’ll do is, I will send you some articles and videos that will help you understand what’s happening there.
Peter: Ok this has been great and very helpful and the articles are of interest to me.
Patrik: Of course, I’ll send you all the information and then if you have any queries get back to me.
Peter: All right, Patrik. Like I said, I really appreciate you doing this.
Patrik: You’re very welcome. I think it’s really helped really helpful to people.
Patrik: Yeah. We know it’s helpful. Okay. Thank you for your call Peter. Bye bye.
Peter: Bye bye.
“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
