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
Day 9 In ICU For My Mom After Stroke, Seizures And Ventilation. How Long Does It Take For Mom To Wake Up?
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 with seizures and is not waking up. George is asking if that is because of her sedation.
My Mom in ICU with Seizures and is Not Waking up. Is it Because of Her Sedation?
“You can also check out previous 1:1 consulting and advocacy sessions with me and George here.”
Part 1
Part 2
Part 3
Patrik: When was the last time she had her eyes open?
George: I haven’t seen her eyes open since this incident happened.
Patrik: Okay.
George: Yeah, that day when I sent you that video, that was when she was having the real bad seizures or jerking and her eyes were … She wasn’t even able to keep them closed. Her eyes were drifting up, but her eyelids were open a little bit.
Patrik: Right. So this video that you just sent to me, just to clarify, is this before or after the cardiac arrest?
George: After.
Patrik: Okay. Okay, I thought so. I just needed to clarify. I thought it was, but I needed to clarify. Okay. Well, that’s good. That’s good. But you are saying she really hasn’t had her eyes open since Monday. Is that what you are saying now?
George: Yeah. No, she hasn’t had them open at all.
Patrik: Okay. Okay. That’s probably partly due to the medications. If they took off some of the sedation especially the propofol and the Ativan, there’s a very good chance that she will open her eyes again because if they are, for example, saying she’s not opening her eyes, well, that’s partly due
to the medications she’s having.
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George: Yeah.
Patrik: If they were to take off medications, she would probably open her eyes.
George: Yes, I think so. They’re keeping her on the medications to stop the-
Patrik: That’s right.
George: … movement, the seizures.
Patrik: Yeah, absolutely. Okay. Just remind me, what time is it for you at the moment? It must be about 2:00 in the afternoon.
George: Yeah, it’s about 20 minutes till 2:00 p.m.
Patrik: Right, right.
George: Now, I sent you one more video, but it’s barely going through and this one was Monday at 2:19 p.m. and this was right when I got there. And this was before we were seeing any seizures at all, but she was moving around, her body. She’s moving around like something’s bothering her, but it didn’t get to the point of seizures until maybe 5:00.
Patrik: Right. Right, okay.
George: The seizures began after I got there.
Patrik: I see.
George: And the last video I just sent you was from 2:19 p.m. That’s pretty much right when I got there.
Patrik: Right, right. Okay, okay. You mentioned to me yesterday, I believe they told you that they worked on her during the time of the cardiac arrest for a minute and a half. Is that what you shared with me?
George: No. They said that they responded to her within a minute and a half and then they walked in seeing the tracheostomy on her chest completely out and the doctor said he was able to put it back in really easy and then they started CPR because her head was slouched down.
Patrik: Yeah, how long?
George: And he said, the whole thing from beginning to end lasted eight minutes, but then another doctor had told me other information that it was only I think three or four minutes total. There’s no one really telling the truth and even the neurologist, she said the report she got is unclear how long she was without oxygen to the brain before they actually went in and seen her.
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Patrik: Sure, sure. Now, I’ve just had a proper read through your email. It says complete revival took eight minutes. Yeah, yeah. You are aware that, and I don’t know how much they explained to you, that the brain in general can’t be without oxygen for more than three minutes before there is irreversible brain damage. Are you aware of that?
George: Yeah, yeah.
Patrik: Right, right. Okay.
George: And that’s the reason why I think the doctors telling me that by the alarm … her heart rate went down, started going down, he said they ran back there and it was only a minute and a half, but her seizures tell me different.
Patrik: Sure. Sure. I understand, understand.
George: But I’m nowhere near as experienced so I don’t know.
Patrik: Yeah. No, no. I understand. Do you know at the moment … Or you know what would be helpful? It would be helpful if you could send me a picture of the monitor. She must have a monitor, right?
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George: Yes.
Patrik: And a picture of the ventilator.
George: Yeah.
Patrik: It would be good if you can send me either because it would be good to know if she’s breathing on her own or if she’s fully ventilated and it would also be good if I see a picture of the monitor. It would be good to know more what are they doing, what are they monitoring, would be good to have both.
George: Yeah. Okay. And I know the respiratory guy came in and told me that her lungs were actually good, but they just have the machine to be sure and that he had it set to where he thought was what she needed just to … He didn’t want to just leave her breathing on her own. He wanted to keep the machine on her.
Patrik: Absolutely.
George: But I’ll send you that picture.
Patrik: That would be good. And the other question is, are her pupils reacting to light? Am I making sense in that? Do you know what I mean by that?
George: Yes.
Patrik: They need to shine a torch in her pupils and if there is any brain activity, the pupils will react to light. If there’s no brain activity, the pupils won’t react to light. I will put all of that in an email, George.
George: Okay.
Patrik: Okay? I really need to stress with you that any discussions around end of life, you’re not going to engage because that is what they might try and do, and I say they might, they might not, but they might try and position your mother’s situation as a hopeless situation. They’re trying to position themselves. It’s going to be important that you position yourself as well until you come to your own conclusions. The minute they start talking
about withdrawing life support, you will say, “Look, I’m not even going there. I need to make more inquiries.” Because they potentially want to rush towards end of life. Just to be prepared. Are you there?
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George: Yes.
Patrik: Right. I know this is a very difficult situation because I’ve seen it so often. I just know what they potentially might say next. They may not, but they may. And if they do, you know what to do.
George: Okay. And right now, her pupils are small and they didn’t make any kind of movement with the light. I used my cell phone light.
Patrik: Okay. You got to ask them about it.
George: They stayed like that. Okay.
Patrik: They should be shining that light into her eyes every hour, every hour.
That’s what they should be doing. I will also email you some more drug names that they could use to stop the seizures.
George: And then the nurse has said too, that you’re welcome to call any of them. Any help is better.
Patrik: Absolutely, absolutely. What’s the nurse’s name again? What’s her name again?
George: Margareth.
Patrik: Margareth. Okay. Okay. Are you still in the room with your mother at the moment?
George: Yes.
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Patrik: There’s one thing I forgot to ask Margareth or can you ask her whether her pupils are reacting to light? Do you think you can quickly ask that?
George: Okay. Hold on. Margareth? Is her pupils reacting to light at all?
Margareth: They are.
George: They are?
Margareth: Yes.
George: Okay.
Patrik: Oh, good.
George: She said that they are.
Patrik: Good. That’s good. That is good. Okay. So why is this important? Patients who are brain dead, their pupils are not reacting to light. So you can rule out brain dead. That’s good. There could be brain damage of course, but she’s not brain dead. So that’s positive. That is positive.
George: Okay. That’s positive.
Patrik: I do believe that is enough information for now. Do you have any other questions at the moment?
George: No. Well, yeah, I do. Do you think the CT scan will show how long she was out for oxygen?
Patrik: No, no.
George: Or there’s no way to tell through that way?
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Patrik: No, but I tell you what could happen is, okay, it will probably be hard to say how long the time was. The only people who can tell you how long the time was, was the people who actually found her and were triggering the response. They’re probably the only people who can tell you. However, the first CT was negative from what I understand from the nurse. They need to do a follow up CT. Sometimes it can take days until brain damage shows up.
The other thing is have you heard of an MRI scan? Have you heard of that term?
George: Yeah, I have.
Patrik: Right, right. I do believe they need to do an MRI scan next. Now, I don’t know whether this particular hospital has an MRI scanner.
George: I think they will, right?
Patrik: They should. How big is this ICU there?
George: It looks like about maybe for 20 patients, 25. It’s small.
Patrik: No, that’s fairly big. That’s fairly big.
George: But the hospital, though, is very large. I think they do deliveries here, too.
Patrik: Okay. So they must have an MRI scan, then.
George: Yes. Yes, they do.
Patrik: Right. So this is then another thing you should bring up with the doctors, ask them, “Can she have an MRI scan?” See what they say. See what they say.
George: Yeah. Right now as I’m looking at my mother, her legs, they’re just totally calm and she’s breathing well, but her legs right now, there’s no movement in her body, no jerking, no nothing. If I start touching her, she’ll start getting those little earthquakes, but right now she’s calm.
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Patrik: Right. But that is on the Ativan, that’s on the propofol. Even though the propofol is not anti-seizure, it’s not potent for anti-seizure. She’s also on Keppra. It is anti-seizure. So they’re giving a fair few things, but the reality is, this has been going on for days. A seizure needs to
stop now. That is my concern. My biggest concern is the seizure activity has been there for days and they haven’t been aggressive to stop it. That’s my concern.
George: Yeah. And over there, they were taking really long to do the CT scan and then they said the machine was broke. They’re a small facility so they brought in a truck to do it outside.
Patrik: Oh my goodness.
George: Then the next morning, they said it was too hot. It was a 105. It’s really hot over here right now. It’s summertime here.
Patrik: Okay.
George: So they said it was too hot to do it outside.
Patrik: What?
George: Yeah. So I just wanted her transferred out of there so at least this may be connected to the same hospital, but it was better because they have more equipment that they need here plus a neurologist.
Patrik: Yeah, absolutely.
George: And, you know what, when I had told the doctor there, that I was upset and I wanted her transferred, he didn’t even try to fight or to protect anything. He just said, “You want her transferred? Fine.” He said, “I’ll have the case worker work on it.”
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Patrik: Good, good. No, that’s good.
George: Basically get rid of her.
Patrik: Yeah. Sure, sure. Let me just ask you this. When your mother first went into hospital a few weeks back, she only was in that hospital before she got transferred? There were no other hospital changes?
George: Yes. Near our home in Clayton, which is about two hours from Gilmer, she went in there to get checked because she had stomach pain and then when they brought her in and said they were going to do emergency surgery, the doctor had told me, “I’m pretty sure she’s going to be on the breathing tube after because her lungs are not good, but,” he goes, “if possible, she won’t have that and she’ll recover right away.” So after the surgery, he said, “No, we’re sorry. She’s not breathing so we have to put a breathing tube in her.”
Patrik: Yeah. Yeah. Sure.
George: And then she was there for about a week and then said there was really nothing else they could do for her so they transferred her to the hospital saying that there were specialists and that they would help her with the breathing. And so she was in the first hospital only about six, seven days.
Patrik: Okay, okay, okay. I just needed to clarify because, yeah, maybe there was other information. Okay. No, that’s fine. Do you have any other questions at the moment?
George: No, not at the moment.
Patrik: Okay. So what do we do from here? Probably best if you give me an update whenever there’s news. I will email you just a few medication names, what else they could do to stop seizures. Remember to ask for an MRI. Remember to ask for a repeat CT scan, and I’ll put all of that in the email. And no talk about end of life until you are ready.
George: Okay.
Patrik: Okay? And you got to be really firm on that if it does come up. Hopefully it’s not coming up, but if it does come up, we will be able to stand our ground on that.
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George: Yeah, okay.
Patrik: Okay? Sorry that I didn’t answer straight away. Even though I’ve got the phone on, it’s 7:00 a.m. for me now and that’s fine. You can call me any time.
George: Okay, thank you.
Patrik: Okay. Thank you so much for now. Let me know what happens next.
George: Okay, Patrik. Thank you.
Patrik: All the best.
George: Bye.
Patrik: Thank you. Bye-bye.
The 1:1 consulting session will continue in next week’s episode.
