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 our readers and the question was
My Mother Had a Cardiac Arrest. Would it Be Possible that the Fluids in Her Lungs Will Lead to Infection?
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 questions from one of my clients Stephanie as part of my 1:1 consulting and advocacy
service! Stephanie’s mother is a post cardiac arrest patient in the ICU and is asking why the doctors are not addressing the fluids in her lungs.
My Mother Had a Cardiac Arrest and the ICU Team Thinks That the Fluids in Her Lungs Is Not an Urgent Threat.
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
PART 7
PART 8
PART 9
PART 10
PART 11
PART 12
PART 13
PART 14
PART 15
PART 16
PART 17
PART 18
PART 19
PART 20
PART 21
PART 22
PART 23
Patrik: Okay. Right. Because we were talking about the family meeting this morning. The family had been informed at the time that she was fluid overloaded but Lasix can’t be given. You’re not aware of that?
Dr. Brendon: I’m not aware of that.
Patrik: Right. Maybe that was misinformation then. Sounds like it.
Dr. Brendon: I’m looking at the notes from today, from the doctors. Hold on one second here. Nobody’s really written about fluid overload or needing Lasix.
Patrik: Right.
Dr. Brendon: I’m not seeing that anywhere.
Patrik: Maybe we heard…
Stephanie: No fluid in her lungs? Fluid in her lungs. They said fluid in her lungs today when we were there. Tonight they said 75%. They took a picture. They took a CT scan of it Dr. Brendon.
Patrik: What’s 75%? I’m not sure what that means.
Stephanie: Her lungs are 75% overloaded with fluid. That’s what we heard. We heard half today and tonight Miranda said someone told her.
Patrik: Okay. You were in a family meeting today with the doctors? Okay I don’t want to…
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Stephanie: You’re fine. You’re fine. We’re just trying to get an update on where she is right now because Miranda was there and she heard something she’s 75% overloaded. She’s 75% with her lungs. So, we’re trying to figure out what are you guys doing to mitigate that. The nurse told Miranda that we cannot give her any.
Dr. Brendon: I’m going to need to review all of this. I can’t answer this right on the spot because I have not heard about any of this. Nobody told me about any of that. I’m going to need to review her records. We’re in the middle of rounds. So, I’d be happy to call you a little later and go over it with you, if you’d like. But, if you got a big meeting today and a lot was discussed. I can’t just recount all that right now. I’m sorry. You’re
telling me a lot of things that I don’t know.
Stephanie: You have a date for the trach then Dr. Brendon?
Dr. Brendon: No. I don’t do the trach. The surgeons will have to put her on the schedule and decide when they can do that.
Stephanie: So, you don’t know a date. Okay.
Dr. Brendon: I know it’s based on the surgeons who do the trach will decide on a date. They haven’t told us.
Stephanie: Okay. Well, I guess we’ll speak to you later, right Pat?
Dr. Brower: Yes that would be great.
Yes I can give you a call…
Stephanie: What time would be a good time?
Dr. Brendon: Maybe about in a half an hour? 45 minutes? Somewhere between an half an hour and hour depending on our rounds and I have to review everything.
Stephanie: That’s fine.
Patrik: Thank you.
Stephanie: That’s fine. We’ll give you time. If it’s an hour, hour and a half. Whatever you need. We’ll be here.
Patrik: Thank you so much.
Dr. Brendon: The other… are you gonna be here tomorrow? Can you speak to the same doctors who told you all this yesterday? Or do you feel like you need that information tonight?
Stephanie: I do need it tonight because I’m concerned about the change in her. Whatever is going on tonight?
Dr. Brendon: Well, nothing has changed from this morning. Whatever information was there, there’s no new information. Nothing has changed. I’m not sure where you’re hearing about this with… I’m not even really sure what 75%… who told you about 75%? I’m not even sure what that refers to. Do you know where that came from?
Stephanie: Yes Miranda. They did a test. I was there when they put the wedge to find out what percentage her body, if it’s not her lungs, then it’s her body.
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Dr. Brendon: Okay. Hold on one second. Do you know where this number, 75%, who said that?
Eva: The doctor in the morning might have-
Dr. Brendon: How do you put this on speaker phone?
Miranda: I’m going to put you on the speaker in a sec.
Stephanie: Okay.
Miranda: Hello, we still about to put them on, I’m about to put them on the speaker phone for you. But I just want to make sure they hear you through the phone. Just a little bit lower if you don’t mind.
Stephanie: Okay. I won’t say anything.
Eva: We can’t get to them right now-
Dr. Brendon: What did he say he was going to do about it?
Eva: He said before he want to do a tracheostomy. He didn’t want to do anything right now.
Dr. Brendon: None of that has changed tonight. What he said this morning. I’m not going to change his plan. The plan was to just keep planning. Nothing has changed.
Eva: But you asked about-
Dr. Brendon: But, they want an update.
Eva: I would ask about that to Dr. Reynolds.
Dr. Brendon: Alright, all right. Are you listening here?
Patrik: Yes.
Stephanie: I can hear a little bit. But, I was there with her when she spoke to Dr. Reynolds and he said at one point he wanted to the arterial line and then he came back into the room when we were just speaking with each other, my own family. He said, “Oh good her mean has come up so we
don’t have to do it.” But if they’re gonna do a surgery, they’re gonna need a central line, arterial line or something. To be able to control things in that area. The vascular area. That’s what I’m thinking. But, he said, we’re going through with three things. These are the three things we’re doing. If we need the arterial line. If her mean
changes. We’ll give her vasopressor. They’ll do that. The second thing is we’ll do the trach. We’ll do the third thing, is we’ll do the PEG. In the stomach.
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Patrik: Right.
Stephanie: I know that they have to get her off of the blood thinners, the Heparin. Then, they will have to then maybe a day. So, we need to know what date. I know you said the surgery. You’ve got to check with surgery. But, somebody’s got a record somewhere, I would think. To when they plan to do it. We didn’t exactly get that before we left. Pardon me?
Dr. Brendon: There is no, they have to post the surgery. They have to go to the operating room, find an open date and then they will inform us when that is. It’s not that we can’t find it. It’s just has not been scheduled yet. There’s no surgeon scheduled.
Stephanie: Uh huh.
Dr. Brendon: So, we don’t know the date. It will not be tomorrow. They would’ve told us if it was tomorrow.
Miranda: It will be three days. We asked them and three days Stephanie…
Stephanie: Well, not necessarily three days. I mean they can do it in less than three days, depending on whether her blood is therapeutic. If the oxygen is in and the platelets are right. All that. Right, Dr. Brendon?
Dr. Brendon: That has nothing to do with me. This is the surgeons that have to decide when they can do the surgery.
Stephanie: Okay, very well.
Patrik: From your perspective Dr. Brendon, nothing has changed. From your perspective, nothing has changed.
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Dr. Brendon: Can we have one conversation here please? Okay?
Nothing has changed in the plan. From this morning. Whatever the doctors have told you about the arterial line that we don’t have to do. The surgery, the trach, the PEG. All of things are the same. They apparently told you they didn’t want to give any medicine to deal with the fluid. I have no reason to change that right now. Nothing has changed. If her condition
changed, then we would possibly give medicine or try something. But, nothing’s changed. I don’t have any updates for this.
Patrik: She’s not fluid overloaded then. Can you confirm?
Dr. Brendon: I didn’t say that. If they told you she was fluid overloaded this morning, then she is fluid overloaded. But, apparently he said, they didn’t want to do anything about it. At that time, they didn’t feel that that was necessary.
Patrik: Okay. If she was fluid overloaded on her lungs, that doesn’t impact on her ventilation at the moment.
Dr. Brendon: Not at the moment.
Patrik: Okay, okay. Thank you.
Dr. Brendon: Okay?
Patrik: Thank you.
Stephanie: Okay.
Patrik: Thank you very much.
Miranda: I’ll talk to them in the morning then. I’m not sure why they aren’t doing anything for her lungs if her lungs…
Dr. Brendon: Did you all talk about this, this morning?
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Miranda: We didn’t go into that. When I started sitting here thinking about it.
Dr. Brendon: I don’t know.
Miranda: Is there any way you can find out?
Dr. Brendon: No.
Miranda: Because at this time of night?
Dr. Brendon: I can’t find out right now.
Miranda: Okay.
Dr. Brendon: There’s no- she’s stable. There’s no urgent threat. There’s no urgent issue. If there was something they felt they needed to do, they would’ve done it earlier. Just because someone has extra fluid, you’re not always going to do something about it urgently. They were probably concerned about the MAP, blood pressure could drop. They probably wanted to monitor it for a day or so. Make sure it was stable. Before trying anything. But,
there’s no urgency to it right now. She’s stable. Nothing has changed from earlier. If they didn’t do it earlier, I don’t feel comfortable doing anything about it now.
Miranda: You okay with that?
Patrik: I’m okay with that. It sounds like there is nothing urgent and whatever…
Miranda: I appreciate y’all on the conversation.
Dr. Brendon: No problem. If there is anything at all Miranda-
Miranda: I’m sorry. Can you say it one more time? She’s still breathing over a little bit.
Patrik: Oh, that’s good.
Miranda: Did she check her chest this morning? They’re fast yesterday. Okay. Thank you. I appreciate y’all.
Dr. Brendon: You’re welcome.
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Stephanie: Thank you.
Patrik: Thank you.
Stephanie: I understand. Well, that’s because I was asking. But, we don’t normally do that.
Eva: I won’t talk anymore.
Miranda: See y’all later. Hello?
Hello.
Patrik: Hello.
Miranda: They said that they heard some complaints. They got no complaints. She was irritated because I was saying I was tired of her walking. So, we got to stay in the room. That’s what she just said.
Stephanie: Oh, I understand that. She’s a different bird, that’s all.
Miranda: Thanks. I can’t at night. I’m sorry.
Stephanie: What is it Miranda? Who you talking to while we on the phone? You walking out? Because we want to make sure you’re not talking to us. Hello?
Miranda: Good night Miss Wilma. See y’all. I’m leaving out. I’m tired here. I’m kinda frustrated.
Stephanie: Mm-hmm (affirmative). I’ll wait til’ you get outside. Everybody’s different. We had rights to speak to him. She don’t want us to be talking to them. But, guess what? We’re not afraid to talk to the doctor.
Miranda: Who are you doing? Wilma, you going out with your sister?
Stephanie: Oh. Helen I’m staying tonight. I would not want to see her.
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Miranda: Actually, I’m going down there. I’ve been here for a while. Lord, I’m so happy Wilma wasn’t there when that was going on because she probably would’ve went off. Goodnight.
Stephanie: Yeah, Lord. You don’t get anywhere like that though.
Miranda: Mr. Patrik, thank you for your patience.
Patrik: Oh, you’re very welcome, you’re very welcome.
Miranda: As I was saying. But, I already told y’all, I know what I know about what I know.
Patrik: Right.
Miranda: I already knew he wasn’t going to really have answer. I already knew him. I seen him one. I know how he handles when he on his rounds.
Stephanie: You don’t know. That’s a lie. Right, exactly.
Miranda: You should have done everything. It wasn’t just him. All three of the people. They were just there not doing but they dig a little bit further and they can see long before that and they could’ve just done. They could see her lungs. But the lady, Eva, I hope we can get through the night with her because evidently I was irritating her.
Patrik: Right. That’s fine.
Stephanie: She knows how to handle her. Go ahead. That’s why you say what Patrik.
Patrik: Yes, Patrik.
Miranda: I didn’t know it was raining like this. Hold up. I got to put my hood on.
Stephanie: Listen to Patrik, Miranda. He’s talking.
Patrik: Please don’t yell. Don’t yell.
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Miranda: Okay, I’m back. I had to put my hood on. It’s pouring down. I apologize Mr. Patrik and I appreciate your patience with me.
Patrik: That’s okay. That’s okay. So look, but I am comfortable that not much has changed for this morning. If he’s saying that fluid overload is not impacting on her ventilation that was my main concern. Right? That was my main concern. If patients are fluid overloaded on the lungs, their ventilation is often compromised. Right? Which is why-
Miranda: But she wasn’t… but hello? Are y’all still here? My phone acting up.
Patrik: I can hear you.
Stephanie: Yeah. He was talking though.
Patrik: I heard a pause. That’s when I said something. That’s why I said something when I heard him finish his sentence.
Stephanie: Okay. I’m quiet.
Miranda: So, my question is Mr. Patrik, normally she do pass a breathing test but they said she didn’t pass her breathing test because the fluid in her lungs affected it and said she was breathing heavier this time.
Patrik: Right. Right. Okay. When I asked him whether her ventilation was compromised, I was eluding to increased oxygen demands and all of that. He would understand that. I wouldn’t have to wander after him. He would understand that. He would know what I meant. But, if her breathing sounds a little bit faster, that happens even when people aren’t fluid overloaded because it’s not…your mom has been on the ventilator now for two weeks. It wouldn’t be the same all the way along. Sometimes she would be breathing ten breaths above the ventilator. Sometimes five. Sometimes twenty. Those things can change. I’m not worried about that. But, what I was worried about is oxygen demand. That’s why I said, “Is her ventilation compromised?” If he says, “No”, I must assume
no.
Stephanie: He answered that. He definitely said, “Not at this time.”
Patrik: That’s right. That’s right. So, I’m quite comfortable with that. If your mom’s breathing at times is erratic, that’s just, that’s for anybody who’s on a ventilator.
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Stephanie: That’s why the lady said, “No big deal.” It’s not important at this time. Now, I understand that. Now I understand why she gave the answer that she did. But, if she had explained it, it would’ve been much, a bit more palatable. I’m talking. I’m talking. If she had explained it, it would have been more palatable to you.
Patrik: Correct. I have no concerns there Miranda. This morning, in the meeting, the only news you really had was fluid overload, trach on Thursday or on Friday and GCS five. There were really the only news. Is that correct?
Stephanie: Mm-hmm (affirmative).
Miranda: Right.
Patrik: Or was there anything else that was new? That you thought, “Oh how did that happen?”
Miranda: Say it one more time. Was there anything… I think he didn’t say anything other than he thinks that we are getting in the way with nature. By keeping her on this stuff.
Patrik: Yes. Was there anything else that was new that you said, “Oh what happened there??” So, the news was GCS five, fluid overload, trach on Thursday or on Friday. Was there anything else that you thought you weren’t expecting…or?
Miranda: No. I wasn’t… I’m just expecting her to or you know or better outcome over time.
Patrik: Yeah, sure, sure. But, I’m talking more about the short term. I’m talking more about the short term. I’m talking more about was there anything that you thought was impact…
Miranda: Let me ask a question.
Stephanie: He’s asking you a question. Was there anything that you thought was new?
Patrik: Yes.
Stephanie: So, the answer’s either yes or no.
Miranda: I thought I said no. I said no a couple of times. I thought I said no. But then started talking.
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Patrik: No, that’s fine. Then, I think we can say fairly safe that then we must trust that he says if there are no changes, that there are no changes.
Stephanie: Other than, they did mention the fact that her body, her body has deteriorated little bit more. That’s understandable because of the swelling. So, in that way, it’s deteriorating because of the lungs. So, that’s a form of bodily deterioration where they have another issue to manage.
Patrik: Very much so.
Stephanie: You know what I mean?
Patrik: Very much so. But, we talked, we spoke about that Stephanie. Every day in ICU, you need to get out there of course. Because it’s muscle wastage. It’s all of that but, that’s something we can’t change at the moment.
Stephanie: Right.
Miranda: May I ask a question?
Patrik: Please.
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Miranda: In references to my mother’s tongue coming out her mouth, when she gets a thing, it looks like her tongue is coming out more and more each day. When she gets the trach,will her tongue go down and kind of go back in her mouth?
Patrik: Absolutely. The tongue is swollen at the moment from the breathing tube. Right? Because there’s a foreign body in the mouth. That’s one of the reasons why the tongue is swollen. The minute that she has the trach and the breathing tube comes out, right? There’s no more foreign body in the mouth and the tongue swelling will go down over time.
The 1:1 consulting session will continue in next week’s episode.
