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 frequently asked question our readers and the question in the last episode was
The ICU is telling me that my mom no longer has any hope of surviving? Can a DNR take effect without
my decision?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next questions from one my
clients Graham whose grandmother had cardiac arrest at home, brought to the hospital, did series of diagnostic tests inside the ICU, placed on induced coma, not waking up for long and eventually died.
My grandmother is in an induced coma after cardiac arrest! Is she brain dead?
Graham: Hello?
Patrik: Hi, is this
Graham?
Graham: Yes, speaking. How are you?
Patrik: Very well, thank you. How are you?
Graham: I’m okay. I’m still at the hospital now.
Patrik: Right. So. Right. So your grandmother had a cardiac arrest on Monday?
Graham: Yeah. Monday night she got cardiac arrest and it took her 30 minutes to get her start running again.
Patrik: Right.
Graham: So right now. I walked into the room a few minutes ago and I yelled out her name, and she ended up opening her eyes. But she’s still under a little bit of … I think they gave her something to calm her down (sedation) during the MRI. So I guess she’s still groggy and sleepy.
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Patrik: She had the MRI today?
Graham: Yeah. She had an MRI a few days ago. And they gave her another one today.
Patrik: Okay. When she had the cardiac arrest …
Graham: And then tomorrow …
Patrik: Sorry.
Graham:
I’m sorry?
Patrik: When she had the cardiac arrest, was that out of hospital, or in hospital?
Graham: No. That was out of hospital. That was at home.
Patrik: Okay. How long did it take for the ambulance to arrive?
Graham: I’m not sure, because I live a few hours away.
Patrik: Okay.
Graham: But she’s 300 pounds, so they needed to call backup. They needed more help on bringing her down the stairs.
Patrik: Right. Okay.
Graham: So overall, it took them about 30 minutes.
Patrik: Okay. In the last week, she had the MRI. Did she have a CT of the brain as well?
Graham: No. I think they just did the MRI and tomorrow they’re going to do the EEG I think it’s called.
Patrik: Yep. Yep. Do you know?
Graham: Yeah. So.
Patrik: Right. And have you got a result yet of the MRI?
Graham: No. We’ve been waiting for about three or four hours.
Patrik: Okay. Okay. And you said in your email initially that you were told her brain was okay.
Graham: Yeah. That’s what they said in the first MRI. I’m not sure exactly why they did another one.
Patrik: Okay. So, look, I’m almost certain they have done a CT of the brain in the first three days. I’m almost certain they would have done that. Which is where they would have got the information from if her brain was intact or not.
Now there’s a number of things that I can see. There are a number of questions that need to be raised. Number one, so for anybody in an induced coma, even if they don’t have brain damage, patients don’t wake up straight away. It can take days, sometimes weeks. So what you’re describing to me here is nothing unusual from an intensive care
perspective. I’ve seen this hundred different if not thousands of times.
Okay. So if they are telling you that her brain is okay, it still makes sense to follow-up with an MRI, but your grandmother would have been in an induced coma at least for a few days. And if she’s not waking up, I’m not concerned at all at this stage. Because that’s what you see over and over again.
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Patrik: How old is your grandmother?
Graham: She’s 82 years old.
Patrik: Okay. And with increasing age, it usually takes longer to wake up. Okay? That’s one thing. The other question I have is, do you know whether she was in cooling therapy? Excuse me.
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Graham: Yeah. They put her on machines to cool her body for, I don’t know if it was a day or two, and then they warmed it back up.
Patrik: Yep. Okay.
Graham: Yeah. So that’s pretty much it.
Patrik: Yep. That’s important information because I’ll tell you why this is so important. If she was in cooling therapy, she would have a lot of medication so she can tolerate the cooling therapy. She would have had a lot of Morphine or Fentanyl, and Midazolam (sedation) which is also known as Versed. Those drugs are very good to put patients in an induced coma. They take a very long time to wear off.
Graham: Oh.
Patrik: Okay? So again, what you are describing there, your grandmother not waking up
after a week in an induced coma, it’s nothing unusual. I’ve seen this thousands of times. You’ve got to wait, patience is your biggest asset in all of this.
Graham: Ah.
Patrik: Are you the medical power of attorney for your grandmother?
Graham: No. Her daughters are, my mother is. I’m just
helping them out, they wouldn’t do any research online!
Patrik: Okay. That’s okay. So when you see her lying there, do you know whether she’s had any seizures?
Graham: No. No seizures.
Patrik: Good. That’s a good sign. That’s a very good sign. A lot of patients after cardiac arrest, who have
brain damage, have seizures.
Graham: Uh huh.
Patrik: Okay. Do you know how weak her heart is? Do you know whether she’s on medications to support her heart (inotropes/vasopressors)? Do you know any of that?
Graham: No. I don’t think she’s on medications for her heart. I think the heart right now is between 90 to 100.
Patrik: Okay.
Graham: Does that sound
right?
Patrik: So what is between 90 and …
Graham: And …
Patrik: Sorry. What is between 90 and 100?
Graham: Well you know the machine that tell the heart rate, and …
Patrik: Oh. Yeah. Yeah. Yeah. Sure. Sure. Yep.
Graham: Okay. So the colour, the first one is 94.
Patrik: Yeah. That’s the heart rate. Yep.
Graham: And then the red, or orange, is 90, 87.
Patrik: Okay.
Graham: And the blue is 99.
Patrik: Okay.
Graham: And the white is 30.
Patrik: Yep.
Graham: And
then the purple is 116. 60 (73).
Patrik: Say that again. 116 (73)?
Graham: Yeah. It’s (73). The purple.
Patrik: Yeah. That all sounds reasonable to me. That doesn’t mean she’s not getting any support for her heart. I’m pretty sure she is getting support for her heart. You see, this is the
biggest problems for families in intensive care. They don’t know what questions to ask. They don’t know what to look for, and this is where obviously having worked in intensive care for nearly 20 years, I know the fine details. And I know that she’s most likely getting support for her heart. Even if she’s not getting any, she would have been getting support for her heart, probably up until the weekend. I’m 100% certain of that, after cardiac arrest.
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Patrik: I’ll tell you what I’ll do as the next step. I will send you some articles around how long does it take to wake up after an induced coma. Because that’ll open your eyes how long it can take to wake up after an induced coma. The biggest problem, I can’t stress this enough for families in intensive care, is they don’t know what to look for. They haven’t seen all of this before. What you are
describing to me is a perfectly “normal” situation in intensive care. It doesn’t look like that to you, of course, because you haven’t seen this before, but having looked after thousands of patients in intensive care, that’s the reality.
So for you this is extremely frustrating because you have not seen your grandmother like this. You want her to wake up. Your grandmother will wake up, but she will wake up in her own time. She will take as
much time as she needs. She’s very sick. She just escaped death, and she will need time. And if she’s not waking up …
Graham: I have a question for you.
Patrik: Sure. Sure.
Graham: So when they check her pupils, it’s dilating twice but slowly. When they pulled the mucous out of her, she’s
coughing, she coughs out.
Patrik: That’s good.
Graham: And when I walk into the room and I screamed her name out loud, she opened up her eyes.
Patrik: That’s good. That’s all good.
Graham: Does that
mean?
Patrik: Sorry, what’s that?
Graham: Does that mean that she doesn’t have brain damage, or that’s not enough information?
Patrik: That’s not enough information. Not enough information. So I’ll tell you how you can find out whether she will have brain damage or not. Number one, the MRI
result will tell you something. Okay?
Graham: Uh-huh.
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Patrik: The EEG will tell you something. Okay? The responses from your grandmother mean something, of course. And the only way you can really find out if your grandmother has brain damage or not, is over time. You don’t know until she’s recovered. And that’s what I mean by that. Coming out of an induced coma, without any brain damage is like switching on a light with a dimmer. It’s not like
switching on a light with a switch.
Graham: Mm-hmm (affirmative)-
Patrik: Right? It’s a process, not an event. Waking up after an induced coma is a process, not an event.
Graham: Is she alive now, from what I explained to you? Is she brain-dead?
Patrik: No. No. No.
You see, this is, no. Your grandmother is not brain-dead. There is a huge difference between being brain-dead and brain damage. There’s a massive difference. Okay. So you have three stages. You have brain-dead, brain damage, or no brain damage. At this stage, you don’t even know whether your grandmother doesn’t have any brain damage. So your grandmother is not brain-dead. People mix this up all the time. Forget about being brain-dead. Your grandmother is not brain-dead. Forget about this term at
all. Just delete it from your vocabulary.
Graham: Okay.
Patrik: Okay? So what I’ll do is …
Graham: That was one of my concerns.
Patrik: Yeah. Yeah. No. No. No. No. She’s not brain-dead. So.
Graham: Thanks,
Patrik, okay!
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Patrik: But I will send you all the information around that.
Graham: Okay. You’re going to send that to my email?
Patrik: Yes, you’ll have it when we come off this call.
Graham: Yes, sir,
that’s right.
Patrik: Yes. No. No. I’ll send it all to you. That will help as a starting point!
Graham: Absolutely. You gave me good news, so far. The internet is what ruins people, you know?
Patrik: It does and it doesn’t. Because if it wasn’t for the internet, you would have never spoken
to me.
Graham: Well yeah. Yeah. Yeah. No. You’re something else. But I’m talking about people that just write false information all the time.
Patrik: Oh yeah. Oh yeah. For sure. For sure. And the reality is people can publish all sorts of things online, of course.
Graham: So I have a
question. Right now she looks very pale, but she’s warm. Is that normal?
Patrik: Look. Again, your grandmother is very sick. Of course she’s pale. Very few patients in intensive care have a healthy skin color.
Graham: Right.
Patrik: And she’s warm, that’s good. She might have a
temperature, she might develop an infection. That wouldn’t be unusual for somebody in a situation like that.
Graham: Alright.
Patrik: The next challenge she might face is a pneumonia. So people on a ventilator, they often end up with a pneumonia. That might be a challenge she’s facing. She might be facing soon. But let’s not put the cart before the horse. Let’s take one
day. Patience, and take one day at a time. And stay positive. No matter what happens, stay positive. It’ll help you no matter the outcome.
Graham: Right.
Patrik: If something bad happens it’ll happen whether you’re positive or negative. Staying positive will help you tremendously. Easier said than done, but it’s doable.
Graham: Yeah.
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Patrik: I’ve got to go, Graham. I hope that helps. So I will send you all the information that we’ve spoken about.
Graham: Okay.
Patrik: And you can then select from the options if you want to have more help.
Graham: Okay. Absolutely. Thank you very much …
Patrik: You’re most welcome.
Graham: I’m going to look for the email.
Patrik: Okay. All the best for now, Graham. Take care, let me know when you want to do the next consulting and advocacy session. As I mentioned to you yesterday, I would also be very happy to talk to the
doctors and nurses directly and I can also participate in any family meetings you and your family might have with the doctors. In fact I would strongly recommend not to go into any family meetings without being prepared! If you’re going into a family meeting unprepared there is a very high chance that you’ll have no chance in getting what you want for your grandmother because the Intensive Care team is just so used to structure and frame the meeting in a way that gets them what they want! Keep
that in mind at all times!
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Graham: Thank you.
Patrik: You’re welcome. Bye-bye. Bye.
Kind Regards
Patrik
