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

 

The ICU Team Says Mom has Irreversible Respiratory Failure but Without Proof. What Should I Do?

 

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 George as part of my 1:1 consulting and advocacy service! George’s mother is critically ill in the ICU and George is asking how come that the neurologist is not disclosing any information regarding her mom’s cuurent condition.

 

My Mom is Admitted to the ICU with Seizures. Why is it that the ICU Doctor is Not Giving Any Good Info about My Mom’s Current Condition?

 

George: Hello?

 

Patrik: Hi, George. It’s Patrik. Yes.

 

George: Hello?

 

Patrik: Hi, George.

 

George: Yes.

 

Patrik: It’s Patrik, yeah, from Intensive Care Hotline.

 

George: Hi, Patrik.

 

Patrik: How are you?

 

George: Yes. Okay.

 

Patrik: I’m so sorry that it took me a while to get-

 

George: Yeah.

 

Patrik: … back to you. It’s 6:00 a.m. for me, but that’s okay. How can I help you?

 

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George: Yeah. Well, I’m sitting here with my mom. I tried to give you as much details when I responded to your message.

 

Patrik: Yeah. I got it.

 

George: Right now, it’s unclear of how long she was without oxygen to the brain. The other IC unit is basically doing a coverup.

 

Patrik: Sure.  Let’s face it.

 

George: Yeah.

 

Patrik: Alright.

 

George: She says right now she needs to find out if it’s seizures or if it’s brain damage and that’s where they’re at right now.

 

Patrik: Have they done a CT scan of the brain?

 

George: Yes.

 

Patrik: Do you know the result?

 

George: And then they did it … No, I don’t know the results yet. She just said that they got to check again to see … that it’s hopefully it’s not brain damage. It’s just seizures.

 

Patrik: Okay. When did they do the CT of the brain and how long ago?

 

George: Last night about 8:30 at night.

 

Patrik: Okay. And nobody has told you about any results yet?

 

George: No.

 

Patrik: Okay.

 

George: That’s what she told me, that she has to find out the difference.

 

Patrik: Yeah, okay.

 

George: I have a phone number here, though, too they told me I could give you.

 

Patrik: Okay. Just give me one-

 

George: That way you could …

 

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Patrik: Just give me one second. I’ll write down this phone number.

 

George: And that’s the ICU. Her name’s Lovely Mendoza.

 

Patrik: Lovely?

 

George: Yes.

 

Patrik: And what’s her surname?

 

George: Mendoza, M-E-N

 

Patrik: Oh, Mendoza.

 

George: … D-O-Z-A

 

Patrik: And that is your mother’s name, is it?

 

George: Yes.

 

Patrik: Okay. Have you got a date of birth, just in case they ask me for that?

 

George: 05/18/1957.

 

Patrik: 05/18/1957, okay. Hang on a second. 05/18/1957 okay. What I’ve seen in the video, how long has she been looking like that? Pretty much for the last few days, hasn’t she?

 

George: Yes. This happened Monday between 8:30 and 10:00 a.m.

 

Patrik: Yeah, yeah. Okay.

 

George: And then I showed up about 2:00 that day after they’d given me the phone call. I live two hours away where she was at, and when I got her and seen her, she was having … Her seizures started when I got there.

 

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Patrik: Alright.

 

George: She was kind of calm and breathing normal and then when I touched her and started talking to her and then she started … It looked like hiccups at first and then it just got real worse and worse and worse. And then the doctors didn’t even want to give her something to stop it until a doctor answered the phone to give the okay.

 

Patrik: Do you know what they gave?

 

George: It feels like that … I think they gave her Ativan.

 

Patrik: Ativan, okay. Do you know any other medications she’s on? Do you know any of that?

 

George: Well, right now I know that they’re giving her dopamine.

 

Patrik: Yeah.

 

George: And then something else that they said that it was anti-seizure medication, but I don’t know exactly. Propofol?

 

Patrik: Propofol is not anti-seizure. Propofol is not anti-seizure.

 

George: Okay.

 

Patrik: Dopamine is not anti-seizure too.

 

George: Yeah. That’s what I’m looking at.

 

Patrik: Yeah, yeah. No, no. I’ll come to that in a moment. I’ll come to that in a moment. Dopamine is not anti-seizure. Propofol is not anti-seizure either. What they need to give her almost as a matter of urgency is midazolam or versed. Have you heard of that?

 

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George: No. I’m not sure what the medications are.

 

Patrik: Okay. I think it would be helpful to get the medications, but I can ask when I call them. When I call this number.

 

George: Yeah.

 

Patrik: When I call this number, who do you think will I be speaking to? Do you know?

 

George: Who is the nurse of the day? That’s you, right?

 

Margareth: I’m the nurse for today.

 

George: Yeah. Yeah. What’s your name?

 

Margareth: Margareth.

 

George: The nurse for her today is Margareth.

 

Patrik: Can you put me on-

 

George: And she’s here, too.

 

Patrik: Can you put me on to her now?

 

Margareth: Here, Lovely. I’m going to give you your insulin shot.

 

George: She’s giving her an insulin shot. She has diabetes, too.

 

Patrik: Right, right. I tell you what they need to give her. They need to give her midazolam or versed to stop the seizures.

 

George: Well, I don’t know what the name of it.

 

Margareth: And she’s also on Keppra.

 

Patrik: Keppra, yeah. Keppra.

 

George: He wanted to see if he could speak to you.

 

Patrik: I think that would be great.

 

George: Rather than just call the number.

 

Margareth: Hello?

 

Patrik: Hello.

 

Margareth: Hello. Hi, Patrik.

 

Patrik: Hi, my name is Patrik. How are you? How is your day?

 

Margareth: Good, how are you?

 

Patrik: Very good. Thank you. Now, I’m George’ friend and I’ve worked in intensive care for a number of years. Just trying to find out, she’s got a lot of seizures at the moment it sounds like, doesn’t she?

 

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Margareth: Well, that’s why we did the EEG to rule out if it is a seizure or if it’s an anoxic brain injury.

 

Patrik: Right. And is she getting any sedation at the moment?

 

Margareth: Yeah, she’s on propofol

 

Patrik: Right, but that hasn’t stopped the jerking or the seizures.

 

Margareth: And she’s on Keppra.

 

Patrik: Right, right. No phenytoins and no versed either? They haven’t given any of that, have they?

 

Margareth: No.

 

Patrik: Right, right.

 

Margareth: She was given Midazolam or versed, but it was stopped because it wasn’t doing anything for her.

 

Patrik: Right. So she had the versed but even that didn’t stop the seizure activity.

 

Margareth: No.

 

Patrik: Right. Right. What about diazepam? No diazepam given either?

 

Margareth: No.

 

Patrik: Right, that’s fair enough. What do you think? What’s your gut feeling? Do you think it’s seizures or do you think it’s an anoxic brain injury?

 

Margareth: Personally, it doesn’t look like a seizure. I don’t know what it is to be honest. That’s why we’re waiting for the results of the EEG.

 

Patrik: Sure.

 

Margareth: That’s why we consulted Dr. Brown.

 

Patrik: And do you know the result of the CT scan of the brain?

 

Margareth: It was negative.

 

Patrik: Okay. Okay. All right. And has there been a neurologist’s review? Has there been neurology review besides the EEG that was done?

 

Margareth: Well, the neurologist is the one that ordered the EEG.

 

Patrik: EEG. Yeah, yeah. I understand that. Okay. Okay. Right. Okay. So her Glasgow Coma Scale (GCS) at the moment really is a three.

 

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Margareth: Yes.

 

Patrik: Right, okay. Okay.

 

Margareth: Okay. Is there any way I can talk to you in a little bit because I have to go to another patient’s room.

 

Patrik: Yeah. If you’re busy, you’re busy. No, no.  If you can put me back on. Thank you so much. Thank you for your help.

 

Margareth: Okay. You’re welcome.

 

Patrik: Yes, bye-bye.

 

Margareth: You’re welcome.

 

Patrik: Thank you.

 

George: Thank you, Patrik.

 

Patrik: Thank you. So they have tried the Midazolam or Versed already, which is what I was trying to find out. And they said it hasn’t stopped. Now, they may not have given enough. She didn’t know how much versed was given. When you showed me this video or this video that you sent me yesterday, just describe to me. This is what it’s been like for the last few days? It hasn’t really changed at all, has it?

 

George: No, it’s been like that. And when they give her, I think it was the Ativan, they calmed down, but if we start talking to her or touch her or the nurses have to come and draw blood or do anything, once you touch her, she starts jumping around really bad. And after a while, you stay quiet around her and she’ll just quiet back down, but she’ll still be moving around. Right now, it’s really mild, but both feet jump back at the same time and she looks like she has hiccups.

 

Patrik: Yeah, it looks like she … Yeah, absolutely. So with the Ativan, do you know why they have stopped it if the seizures stopped while giving it? Have they given you any reason why they stopped that? You know what I’m saying?

 

George: No. I think they’re continuing it every four hours or so. When it wears off, she starts getting a little worse.

 

Patrik: I see. I see. Who have you spoken to in the meantime? Have you spoken to a neurologist? Who have you spoken to in the last few days?

 

George: Yeah, just the neurologist. At the other location, they wouldn’t really-

 

Patrik: Engage.

 

George: … talk to me at all.

 

Patrik: Terrible.

 

George: They weren’t giving me any kind of good info.

 

Patrik: That’s terrible. That’s so disappointing. Oh my goodness. How long has she been in this new facility now for? Hours?

 

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George: This is her second day. Yeah, hours. She transferred in last night around 8:00.

 

Patrik: Okay. And who have you spoken to at this place so far?

 

George: Only the neurologist probably about a hour ago right after when she was taking a look at the results of the CT scan.

 

Patrik: Okay. Okay.

 

George: So she’s going through the results again right now to try to figure something out.

 

Patrik: Okay. The nurse told me at the moment they’ve got the result of the CT scan, which was negative apparently.

 

George: Yeah.

 

Patrik: And I’ll tell you that doesn’t mean anything because brain damage often shows up days later so it doesn’t mean anything.

 

George: I could send you also another video of the first day when I got there, how her … It got worse from the point when I did the video, but it does show where her eyes are open. She is staring off into the ceiling and her eyes are open, fully dilated and her body’s just jumping a lot. And I took a video because I need any kind of help or any kind of advice from anybody.

 

Patrik: Yeah. Now, let me ask you this. Has there been any talk about DNR? Do you know what I mean by DNR?

 

George: No.

 

Patrik: You have never heard of the term DNR?

 

George: No.

 

Patrik: No, that’s okay. DNR stands for do not resuscitate. Does that make sense?

 

George: Oh, yeah.

 

Patrik: Has that been discussed at all? 

 

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George: Yeah. This was discussed with my mother before she even went into surgery and she wants at all to be saved no matter what.

 

Patrik: Okay. Good, good. And the reason I’m asking this, it could come up as a point of discussion. It could come up. And if that’s the case, then you just reiterate what you’ve just told me, that your mother’s wishes are to have full treatment.

 

George: Yeah.

 

Patrik: Okay. And I’ll leave it there for now. If that becomes an ongoing issue that they do bring it up over and over again, we can talk about that if they do bring it up. For now, that’s all you need to know. And if they do bring it up, that you say, “Look, my mom wants full treatment.” That’s all you need to say for now.

 

George: Yeah. Okay.

 

Patrik: Okay.

 

The 1:1 consulting session will continue in next week’s episode.