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 and the ICU Team Thinks That the Fluids in Her Lungs Is Not an Urgent Threat.
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 Mom is in the ICU and is Fluid Overloaded. Are They Watching the Fluid Balance Closely?
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
PART 24
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.
Stephanie: Mm-hmm (affirmative).
Patrik: Right?
Stephanie: Does that answer your question?
Miranda: I understand, thank you. My other question is they told us that the pneumonia had cleared up a day ago. Then today, they mentioned her lungs has fluid and pneumonia again from what I think I heard. How did it come back in one day?
Patrik: That’s a good question. I don’t know. Which is again why I asked him, have there been any changes in terms of ventilation. I don’t know why the pneumonia came back. I don’t know why she’s fluid overloaded. Her kidneys seem to work. Right? That’s at least the last thing that we’ve heard. But, what I didn’t say to you Stephanie earlier before Miranda came on the phone. Miranda, what happens is in Intensive Care, the doctors and the
nurses need to maintain the fluid balance every day. What do I mean by that? They need to measure what’s going in and they also need to measure what’s going on. Right?
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Miranda: Right.
Patrik: Because if let’s just say, I’ll give you an example. For example, if your mother was a litre positive every day in fluid balance for the last five days. That means she would be five litres positive. Which means she would be very swollen. Am I making sense here?
Miranda: Yeah. I understand what you’re saying.
Patrik: Right. So, if she’s fluid overloaded, right? My question to the doctors and the nurses would be what’s the fluid balance like? Right? What has-?
Stephanie: Or right now?
Patrik: The last five days of fluid balance, what does it look like? I can tell you nine times out of ten in Intensive Care, you want to keep a patient dry. By that, I mean, nine times out of ten, you want a negative fluid balance. That means you’re taking more out than you’re giving in because for exactly those reasons. You need to keep the lungs dry. But, you can already see the swelling, right? Right? That is a concern. You do want to not
have the swelling. Right? Sometimes, for whatever reason, they’re not watching the fluid balance closely, that’s when people get fluid overload.
Stephanie: Right.
Miranda: I’m saying, I agree with you because every time, they asked us every time the days I’ve seen him, they say, “How much urine is she given out.” If she’s given that much urine, then why was it, “Oh they kept giving her fluid and one time because something wasn’t right. Maybe, the temperature or the blood pressure, one of them. They said they had to keep giving her the fluid. Do you remember Stephanie? One of them two, it was between
those two. Between the blood pressure and the temperature. That’s why they started giving her fluid. But, I would agree with you too. If they are balancing out and doing whatever they need to do because watching her intake and her urine, etc. then she shouldn’t have fluid overload.
Patrik: Absolutely. Do you remember a couple of days ago or yesterday, they were giving her some blood transfusions from what I understand.
Stephanie: Right.
Patrik: Right? That would get her fluid balance in the positive in no time.
Stephanie: Really?
Patrik: Oh yeah. Yeah.
Stephanie: When did they give her the last bag of blood, Miranda?
Patrik: Even if they give her a bag of blood, it would increase…
Miranda: I though they gave her a bag of blood last night Stephanie. I thought.
Patrik: Right, right. So that would…
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Miranda: I think that’s what they called us on. They said the count went up. If I’m right, down one of those two.
Patrik: Right. Right.
Stephanie: We don’t have any update on the blood. Specifically I mean. You were saying, Patrik?
Miranda: I wish I was stronger.
Patrik: Right.
Miranda: I would probably start… go ahead. I apologize. Go ahead sir.
Stephanie: You’re doing fine Miranda. You’re doing fine. It’s hard to ask for all the questions to ask.
Miranda: I wish I was stronger because maybe we can get an update from the doctor every morning. I don’t want to keep talking to the nurses. Unless…
Stephanie: Well, we can do that Miranda. But, this doctor is not the one. I don’t think. I think… I mean, Patrik can talk to anybody but I just think we’re going to have a better outcome if we talk to somebody tomorrow morning.
Patrik: Miranda, the last two times I spoke to the nurses, which would’ve been Mr. Mikael and then the lady yesterday.
Stephanie: Yeah. Excellent.
Patrik: I have felt that I got every information that I needed from them to guide you. That’s how I felt. The doctor now was a little bit more, initially he was a bit defensive but I think in the end we got through to him. I don’t really mind whether I talk to a doctor or a nurse. I believe we can get the information that’s critical from either. Right? Even if we can’t, we can then always take the next steps. But, I still believe if we talk
to a nurse, we get more information in the meantime. Rather than waiting for a doctor. That’s how I feel. We’ll get some information…
Miranda: I understand what you’re saying. But…I understand what you’re saying but what I realise, what I believe is that they tend to give different information like easily.
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Stephanie: Well that’s okay. We’ll reconcile that information.
Patrik: I don’t feel that way.
Stephanie: At least we’re getting information. He doesn’t feel that way.
Miranda: Okay, no problem.
Stephanie: We’ve reconciled that information because if I could interject. The doctors get the information from the nurses.
Patrik: Very much so, very much so.
Stephanie: They go to them. Because we don’t know nothing. He got all his information he was getting, he’s getting report from a nurse. The nurse is doing all the reports. On all the tests. The nurses are doing it. The doctor’s not. He’s just analysing what they’re giving him to see what he needs to do to help that patient.
Patrik: Correct.
Stephanie: Okay you’re telling me we got one plus two. Okay then we need to do this. You tell him, we got A, B and C. Then we need to do this. The nurse is the one who’s giving him, who’s feeding him the information. So that he can make a decision
Patrik: Correct.
Stephanie: So, I’m thinking it’s not so bad. Actually the nurse is closer to the situation. When you’re on jobs and stuff and doctors and people supervising, make decision, we have different procedures that go down. And you hear us saying, well they never talk to us about it. Here, we’re the ones who’s closest to the job. The person closest to the job is the nurse.
Patrik: Yeah.
Stephanie: In this situation as well.
Patrik: Okay.
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Stephanie: And if there’s any different and I think that if it’s any differing information, Patrik will be able to design that, so will we.
Patrik: Yeah. You see Miranda. I tell you where the confusion might be for you. The confusion for you might be that when I talk to the nurses and you listen to that, that it sounds differently to you. They give different, like Mr. Mikael on Saturday night, he gave me different information compared to what they lady told me on Sunday night, I believe. Right? But you gotta keep in mind, not only do they have different styles of communication,
you also got to keep in mind, things are changing. Sunday night would’ve been different compared to Saturday night. For me, I can put it in perspective.
Miranda: Okay.
Stephanie: Because of your experience.
Patrik: It might be very confusing for you. I get it. That might be very confusing for you. But, I have no concerns, as long as I can get information, that’s the main thing.
Stephanie: It is.
Patrik: People are different. I’m not worried about…
Stephanie: Personalities.
Patrik: Exactly. Personality. Or you were a bit worried Miranda in the beginning, you can’t get this doctor on the phone. Just keep asking. That’s all. Just keep asking. It’s nothing. No big deal.
Stephanie: We got an important piece of information out of that…go ahead Miranda. You’re fine.
Miranda: I heard what you was saying. I was just wondering was there anything else y’all needed from me or wanted to discuss.
Stephanie: I just want to tell you that one piece that I was happy with. What little bit information we got from Dr. Brendon was a big piece of information. Even though it was one simple question. It was a big piece of information. When he asked him about whether or not the fluid in the lungs was affecting…
Patrik: Ventilation.
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Stephanie: Her. How much oxygen she was getting or whatever. How did you say it Patrik? Say it to me.
Patrik: I asked whether the fluid overload was impacting on her ventilation.
Stephanie: Exactly.
Patrik: Right.
Stephanie: Very clear, precise and simple. And he said no.
Patrik: Correct. Correct. He clearly said no.
Stephanie: That lets us know that she’s not in danger.
Patrik: Correct. That’s all we wanted to know. For now.
Stephanie: Just that piece.
Patrik: Yes. Yes. He didn’t know anything about the Lasix. Again, it’s still bit of a mystery for me why they mentioned that.
Stephanie: Mm-hmm (affirmative).
Patrik: But, we’ll find out. We’ll find out if we can talk to a nurse or tomorrow morning potentially. Or even now. We can potentially find out what’s happened with the Lasix. I’m very confused by this statement even because I really don’t know what to make out of it.
Stephanie: Mm-hmm (affirmative).
Patrik: Because he didn’t, Dr. Brendon didn’t know anything about it. That to me is strange.
Stephanie: Right. Dr. Reynolds is the one who said that we don’t want to give her Lasix because it will bring her blood pressure down low.
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Patrik: Yes.
Stephanie: Because of course everything’s constantly changing.
Patrik: Yes. Absolutely.
Stephanie: That may have been yesterday. I mean this morning, this morning. Then when he went and checked it, he was like her MAP or whatever it is, is good.
Patrik: Yes, yes. It doesn’t make any sense. If he’s telling me that nothing has changed. Then, we must assume that’s correct. What does worry me and maybe I should’ve asked him, now that we…did you mention that she had a CT scan of the lungs yesterday. Is that what you mentioned?
Stephanie: Yeah. Miranda? Miranda you still here?
Miranda: Yeah.
Stephanie: She’s gone.
Patrik: So, that could’ve definitely been a question why they were doing that. Was that before or after the meeting?
Stephanie: After the meeting. After we talked to the lady.
Patrik: So, with that?
Stephanie: Miranda, let Miranda say what she was going to say. Go ahead Miranda. You said yes but.
Miranda: I don’t know but I’m getting super overwhelmed. For this last hour and a half.
Stephanie: It’s going to be all right. Just answer this one question then we’ll let you go.
Miranda: The question was, the lady…I just don’t want you to get frustrated with me Stephanie.
Stephanie: I’m not baby. I’m not, I’m not.
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Miranda: A lady, until I said something, I said I asked y’all two days ago what was going on…with the fluid in her, etc. so that’s when somebody got a doctor to order the CT scan or whatever. Whatever they did.
Stephanie: Okay Miranda, we’ll let you go. Okay? You okay?
Miranda: Okay. I’m just overwhelmed too much right now.
Stephanie: I understand Miranda. We got you. We love you. Where you headed at now? You headed home?
Miranda: I’m at Sarah’s house. I just walked in.
Stephanie: Okay then. Love you. Take care. Alright?
Patrik: All the best Miranda.
Stephanie: It’s going to be alright. Okay?
Patrik: Thank you.
Stephanie: Good night. Get some rest get some rest, okay? I’m sorry. Thank you.
Patrik: That’s okay.
Stephanie: I don’t mean to be overbearing Patrik. I’m just trying to get…
Patrik: No, no, no. Not at all. Look, if I sometimes try to be too pushy there…
Stephanie: No, you’re not.
Patrik: I’m glad you’re reeling me in because you know Miranda. I can get a sense of where she’s at. But, you know her obviously. I can see how difficult this is for you, for her. I can see how she’s struggling. She doesn’t want to be too pushy with the doctors and the nurses. But, let me ask you this. So, in the meeting this morning, they didn’t tell you anything about this CT scan, did they? That’s it’s going to happen.
Stephanie: You know what. You know what. Man, you said a mouthful right there.
Patrik: They didn’t say anything did they?
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Stephanie: They didn’t even mention a CT scan. Okay? They said that her lungs were overloaded. They didn’t say how they knew. They didn’t say they gave her a CT scan or anything. Because all his goal was to push us to not, forgive my- give my mother a better quality of life. That’s what they were…I think honestly I think, they knew she was swollen a couple of days ago and I think because I hope I am, most of the time they never know. That
they were going to try to do this, ignore it too, that’s a tough situation. To try to force us to let her go and get her out of ICU. I hate to say that but like we said, they’ve got private agendas. We may or may not know what that is. We may not be able to put it into terms. They talk about them and say hey, this is our agenda. But, you don’t know what they’re doing sometimes and why they’re doing it. Do I trust them? No, I do not.
Patrik: I’m very surprised that you had this meeting and two hours later or whatever, they’re doing a CT scan without you knowing about it. That to me is bizarre.
Stephanie: No that’s not right. Correction. Correcting. Let me, I first called you, I paged you on Sunday. I talked to you Sunday morning at three. Then, we talked to you again on Sunday evening at our family meeting, our personal family meeting at six. Not six. It was supposed to be six. Probably like eight.
Patrik: Yup.
Stephanie: Okay. At the moment when we were speaking to you around eight, Miranda had talked to…he had called, we had called, the hospital at that time. Miranda was saying that it wasn’t until after she spoke to them on that night. On Sunday night, that they started to do the CT scan. Now, they did not do, they did not, this was not in the hospital meeting. Where they did the CT but, when we went this morning, this is Monday, they didn’t say,
we did the CT scan, I recall, them saying we did a CT scan of her lungs but I could sense he did because Dr. Reynolds I showed the test. It may be said CT. He showed it to Rebecca and Rebecca saw the picture of where her lungs was half full. He used that to scare Rosetta into saying, she said that we should let Carmen go.
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Patrik: Right. Right. Right. That’s inappropriate. That’s inappropriate.
Stephanie: Yeah. He’s clever. That’s what you’re dealing with. That’s what we’re dealing with. If we take that to him, but then he said, “Oh I work for you. I do whatever you want me to do.” That’s when I said, I told him what we wanted to do. We had decided to do. We decided to do the trach. That’s what we decided to do. You’re not going to let her go. We feel like you’re not going to just not give her a chance because you don’t know and we don’t know. If you try to wean her off of this, they said, she’s not on any…I said well by definition, by hostile is sepsis. Regardless of how much, this is sepsis. Whatever the other
medicine. The seizure medicine. Don’t try to scare me. We know…
Patrik: I think the next step is if we can, talk to the nurse tomorrow morning. I think that’s the next step.
Stephanie: She’s a good one too.
Patrik: Yeah. I think that’s the next step.
Stephanie: Now Patrik, she comes on at seven but you know it takes us a while to…
Patrik: Yeah, yeah. To hand over.
Stephanie: To get you. That’s why I had to get you around. So, I’m thinking a good time would probably be nine or ten because she is in here. Nine or ten, then we’ll get it settled. Check their patients, they know what’s going on. I’m thinking…
Patrik: Why don’t you instigate that? Why don’t you let?-?
Stephanie: I’ll talk to Rosetta.
Patrik: Yeah. Talk to Rosetta. Get a time. Then we’ll line up the time.
Stephanie: Sounds good. Sounds good. So, that’s what we’ll do.
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Patrik: Okay
Stephanie: I appreciate you again. Thank you so much Patrik.
Patrik: Thank you so much. Have a good night.
Stephanie: You’re welcome. You too.
Patrik: Bye-bye.
Stephanie: Bye.
The 1:1 consulting session will continue in next week’s episode.
