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 Mom is in the ICU for Pneumonia. Which Should Be the Priority, Abdomen, Kidneys or Lungs?
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 Julie as part of my 1:1 consulting and advocacy
service! Julie’s mother is in the ICU for Pneumonia and is asking if her mom’s bloated abdomen gets treated on time.
My Mom is in the ICU for Pneumonia. Will I Resort to Surgery For Mom Or Is It Too Late?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Julie here.”
PART 1
PART 2
PART 3
PART 4
PART 5
Patrik: Hi, Julie. How are you?
Julie: I’m good. How are you?
Patrik: I’m very good, thank you. How is your mom?
Julie: So, we’re here. Her tummy is continuing to get more and more bloated. They have the infection disease control doctor up here, and she is debating what medicines to put her on to help with the infections. The blood work came back. She does have an infection in blood, and in her urine.
Patrik: Right, okay.
Julie: They’re going to treat her with some antibiotics to help that.
Patrik: Mm-hmm (affirmative). Yesterday we spoke about your mom being on a lot of support for her blood pressure. Do you know whether that’s still the same, or that’s changed, whether it’s gone up or that’s gone down?
Julie: For the blood pressure medication? Let me go find out about that.
Patrik: I could also… Are you at the bedside?
Recommended:
Julie: Yes.
Patrik: If the nurse is happy to talk to me, I’m very happy to talk to the nurse, or I can talk to you. However, you want to go about it is fine with me. Whichever way you want to manage this-
Julie: Okay, let me see if the nurse will talk to you on those updates today.
Patrik: Sure.
Julie: Can you look for and locate Russel, her nurse. Which one is her nurse? Can you also tell the doctor to talk to a family friend that’s a nurse is kind of available for today? Would you want to talk to the infectionist disease doctor?
Patrik: Yes, I wouldn’t mind talking to her. However, I think to get… The infection disease doctor will probably only look at the infection, right? To look at the bigger picture, the nurse could probably give me a quick rundown if she’s available. Right? You see, the-
Julie: Okay, I just don’t-
Patrik: Sure.
Julie: No, I just don’t see her right at the moment. But yes, if I can grab her.
Patrik: You know what we can do? What I’ll do next is I’ll also send you an email or a text just with regular questions that you need to ask. Because by asking-
Julie: Okay, perfect!
Patrik: Yeah, yeah. By asking those questions you will get a very good understanding of what to look for and what to pay attention to, right?
Julie: Yes.
Patrik: Right? So, I will do that when we come off this call. But in the meantime, so the infectious disease doctor has basically looked at the result and has commenced some antibiotics. Is that right?
Julie: Yes.
Patrik: Yes, and that’s a good sign. You see, one of my concerns yesterday when you and your family first contacted me, my biggest concern is always, especially when they start talking about end of
life and what not, my biggest concern is always they not doing everything within their power. Are they already winding down her port? Now, I have no evidence for that at all. Right, I have no-
Julie: Other, good.
Recommended:
Patrik: I have no evidence that they’re not trying everything that they can, because the other thing that was going through my mind, Julie, was that you mentioned yesterday potentially transferring her to another hospital.
Julie: Yes.
Patrik: Right? Is that still something that is going through your mind?
Julie: It is my aunt’s mind because she just doesn’t trust very easily. But it’s not mine because of what you told us, that everything’s being done. So that built a lot of trust for me in where we are currently.
Patrik: Okay. I do remember yesterday that you mentioned that the hospital is fairly small.
Julie: Yes.
Patrik: How many beds are in this ICU, roughly?
Julie: I would say maybe… I really don’t know. I’m going to go 5 to 10.
Patrik: 5 to 10. Okay. So that is small. That is small. In a unit that’s smaller than 10 beds, or up to 10 beds is small, right?
Julie: Yeah.
Patrik: It’s good that you’ve picked up on that. The rationale behind that is really a smaller unit doesn’t see as many sick patients as a bigger unit. Right?
Julie: Okay.
Patrik: In a smaller unit, 5 to 10 patients, there would be some very sick patients, but the chances are, patients are not as sick as in a big metropolitan ICU.
Julie: Okay.
Patrik: Right? Which means related learning exposure to really sick patients is limited.
Julie: Other.
Patrik: Right? On a scale from 0 to 10, 0 meaning a low acuity admission to ICU, and 10 meaning patients really, really critically ill, your mom would be at an 8. 8 or 9 I would say.
Recommended:
Julie: Okay.
Patrik: Right?
Julie: Yeah.
Patrik: You know? So, the question really is, how much exposure do they have to that high acuity patient like your mom is? Okay. Now again, I have no indication that they’re not doing the right things at the moment. I really have no indication. What is important that, when they have the talk to you on Friday, I believe, about end of life potentially, you have two options and whatnot, it’s very important to look for alternatives as well as
words-
Julie: Here’s-
Patrik: Yes, go on.
Julie: Patrik, the infections doctor said she’ll talk to you right now.
Patrik: Great, thank you. Thank you.
Julie: Here she.
Patrik: Thank you.
Melrose: Hi, Melrose Delgado, I’m a doctor in infectious disease.
Patrik: Hi, my name is Patrik, I’m a family friend. I’m a nurse and Intensive chemist by background, I’m just trying to make sense for the family what’s exactly happening in terms of infection and bowel perforation or no bowel perforation.
Melrose: Yeah, and you said you’re a nurse or a doctor?
Patrik: I’m a nurse, I’m a nurse.
Melrose: Okay. I’m having a little bit of a hard time hearing you-
Patrik: Sorry, it’s that better? Is that better?
Melrose: It’s a little better, yes.
Patrik: Sorry-
Recommended:
Melrose: Yeah, that’s better.
Patrik: Okay, sorry.
Melrose: So anyway, I’m just meeting her, I’m meeting Liza for the very first time. I just literally met her.
Patrik: I see.
Melrose: But her critical care doctor called me when her blood culture turned positive, and it’s an enterococcus, so I’m changing her antibiotics around a little bit, but I’m very worried about her belly.
Patrik: Yes.
Melrose: Her belly’s bloated, and she hasn’t had a bowel movement since she’s been in the hospital-
Patrik: That’s right.
Melrose: She’s been here since what? The 16th? So that’s very concerning to me. So, I’m about to call the gastroenterologist to see if there’s anything they can do, either scoping her or mechanical decompression or something to get her bowels moving. Because she also has air in the wall of her colon, which I don’t like.
Patrik: Yeah, yeah. Yeah, yeah.
Melrose: I don’t like it.
Patrik: Right.
Melrose: Something with her bowels.
Patrik: Right, and is there any evidence of a perforation or is it just ischemic gut?
Melrose: Well, it could be ischemic gut, that’s one of the things I’m worried about. That’s bad.
Recommended:
Patrik: Absolutely.
Melrose: You know, I don’t see any free air. To suggest overt perforation, and if that happens, she’d definitely need a surgeon right away. We might get a surgeon’s opinion also, but I wanted to start with the GI doctor to see if they have any suggestions, because I’m just worried about her colon.
Patrik: Oh, absolutely. My understanding was that yesterday she was on high doses of vasopressors, like 80 of norepinephrine, and Epinephrine and whatnot. I would imagine taking her to surgery would be high, high risk on those doses of vasopressors.
Melrose: Yeah, I think they’ve come down. She’s on 40 Phenylephrine right?
Patrik: Oh, okay.
Melrose: That’s down from yesterday on Phenylephrine. She’s down on her vasopressors today.
Patrik: Oh, great.
Melrose: But she has a little bit of up and down. They just dial it to titrate to her blood pressure. So, she’s definitely a septic picture, and she’s on vasopressors for sure. Right now, she’s on 40 Phenylephrine.
Patrik: Okay, okay. All right. Look, thank you so much for your update, and thank you for everything you are doing. We really appreciate.
Melrose: Where are you? Are you here in town?
Patrik: No, I’m not in town. I’m in the states.
Melrose: Are you in somewhere-
Patrik: Yeah, I’m in the states. I’m in California.
Melrose: Okay, you sound Australian, and I-
Recommended:
Patrik: I have lived in Australia for a long time.
Melrose: I was trying to peg your accent. Anyway, she’s a very sick lady, and I want to get a few things going, and I’m about to talk to the gastroenterologist and her critical care doctor.
Patrik: Thank you.
Melrose: I’ll be here again tomorrow, and we’ll modify the antibiotics as we need.
Patrik: Thank you so much. I really appreciate it.
Melrose: You’re welcome.
Patrik: Thank you. Bye-bye. Hello? Hello?
Julie: Hello?
Patrik: Hi, Julie, are you back?
Julie: Yes.
Patrik: So, she was very nice. She was very nice, and again, I have no indication that they’re not doing everything they can.
Julie: Okay.
Patrik: Right. Yesterday I mentioned to you that she was on high doses of vasopressors like the norepinephrine and the epinephrine, and I asked her about that, and she said the doses have been halved, which is good.
Julie: Okay.
Patrik: So-
Julie: Oh, good, okay.
Recommended:
Patrik: Yeah, yeah. Why is this important? You may remember from yesterday that she’s on two levels of life support at the moment. Number one is the ventilator and number two is the vasopressors which is the Norepinephrine and the Epinephrine, right? Without ventilation and the Norepinephrine, or the Epinephrine, she would probably pass away. Okay, so she’s on those levels of life support, that’s keeping her alive at the moment. But they halved the doses of the Vasopressors, which is really good. You may remember, yesterday I said
she couldn’t go to surgery because she probably wouldn’t survive. Because of those high doses of life support. Now they’ve halved the doses, I do believe, doing surgery would still be very high risk.
Julie: Okay.
Patrik: But she also confirmed what the nurse said yesterday, that there is no evidence for a bowel perforation. Okay, there’s no evidence for that. It is what she thinks, and what she refers to as ischemic gut. Have you heard of that? Ischemic gut?
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
Patrik
