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 Dad is in ICU with Tracheostomy and Has Lots of Secretions. Is it True that the Biggest Risk for Him is Aspiration?
You can check out last week’s question by clicking on the link here.
In this episode of “YOUR QUESTIONS ANSWERED” I want to answer a question from one of my clients Paul as part of my 1:1 consulting and advocacy service! Paul is concerned about his dad not waking up
in ICU and he is asking what should he do.
My Dad In ICU Is Not Waking Up. What Should I Do? Help!
“You can also check out previous 1:1 consulting and advocacy sessions with me and Paul here.”
Part 1
Part 2
Part 3
Patrik: Hello Paul. Patrik here of intensive care hotline. Can you see me in this call?
Paul: I’m going to try to, now I can see you now. I can see you. Okay. I’m going to use my iPad. Okay. The nurses here are doing some work here.
Patrik: Okay. Great.
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Paul: So, the nurses here with me, Lilac, she’s doing a great job. I have a family friend online right there after, so did you want to see the monitor here?
Patrik: That would be great.
Patrik: Yeah, he’s in an irregular heart rhythm. Yeah. Is he in AF? Do you know what I mean by atrial fibrillation? Yeah. Is that new?
Paul: I don’t know. I think so. I don’t know.
Patrik: Do you think we can talk to the nurse?
Paul: Okay. Yeah. She’s busy.
Patrik: So afterwards I think we can, it’ll be good to run the nurse through a series of questions as long as she’s okay with that. I’m sure we’ll get heaps. We’ll get lots of information from that.
Paul: Here, again. I’ll show you the display.
Patrik: Yeah, so, okay. Can you show the display again? Yeah. Okay. Yup. No. That’s probably enough information. Do you know if your dad has been in an irregular heart rhythm before?
Paul: I don’t know.
Patrik: Because that could be one of the changing factors that sort of leading to his deterioration. You were telling me on our last call a couple of weeks ago, your dad was before the COVID, he was fit and healthy.
Paul: Yeah, pretty much. He was a healthy 79-year old.
Patrik: Yup. So the AF or atrial fibrillation is a concern. But I hope we’ll get more information from the nurse. Is your dad at the moment, it’s the nurse only looking after your dad or is the nurse looking after more of the other patients as well?
Paul: I’m not sure, don’t know.
Patrik: Okay. At the moment is your dad awake?
Paul: Not really. No, he’s sleeping.
Patrik: Okay and does he have any infusions running?
Paul: No, I don’t think so.
Patrik: Okay. So that means he can’t be on Levophed. If he’s got no infusions running, he can’t be on Levophed.
Paul: Okay. I’m not sure what do you mean by infusions?
Patrik: Does he have anything going into his body that you can see like an intravenous infusion?
Paul: No, he’s not waking up. Now my dad’s not waking up right now. He’s not conscious.
Patrik: But the numbers on the monitor didn’t look too bad Paul. Certainly, a little bit concerning, but they didn’t look like they were completely off.
Paul: So, he’s not waking up. They’re bringing another nurse in right now.
Patrik: Can you show the screen again? If you can. Yeah, I could see you were standing next to some infusions. I could see that. I can’t read it. Can you read it out? What’s going on there?
Paul: Yeah. We need to wake my dad up Patrik. Levophed, VTBI 25 milliliters per hour.
Patrik: Okay. Okay. All right. So that’s a little bit of Levophed.
Paul: Yeah. I think my dad is sleeping away, Patrik. Right. I’m going to go.
Patrik: Okay, please call me. Call me back anytime. Call me back.
Paul: Anytime I call you back into there. Thank you.
Patrik: Thank you. Thank you. Bye.
Patrik: Hello Paul.
Paul: Hi Patrik. The nurses are busy again and she can’t really talk to you directly.
Patrik: Okay. That’s fine. I tell you what I’ll do. Just give me a second, if I type out some questions here.
Paul: Yeah. Just give me a second. Okay. Okay.
Patrik: Oh, I know. Okay. Here’s the first question.
Paul: Yeah. She actually mentioned that they are treating the heart rhythm or are there, I don’t know how though,
Patrik: Right? Probably I’ll tell you how. Either with Amiodarone or Digoxin. I’ll type that here or potassium replacement.
Paul: Okay.
Patrik: Then IV antibiotics would be important to know.
Paul: Yeah. She said that he was, but I didn’t, he did indicate which one, but I forgot the name.
Patrik: Okay and are you sure? No central line or PICC line.
Paul: No central line. I asked her about that. They said that they’re going to discuss that when the hospitalist does rounds today,
Patrik: Right. I argue that he should not be on Levophed without a central line. Okay. Then, you know if they have done any arterial blood gas?
Paul: Yeah. They did yesterday.
Patrik: Okay. Do you have any values?
Paul: He would have them.
Patrik: Okay. How much oxygen is he on at the moment? Do you know?
Paul: Yeah, he said He’s at 45 liters and it looks like, I’m not really sure how to read the oxygen on the floor.
Patrik: Yup. Sounds like he’s on 45 liters of flow.
Paul: I think it’s a 90%.
Patrik: Okay. Alright. That’s certainly a lot.
Paul: It is a lot.
Patrik: Okay and the only sedation he is getting is Ativan as far as you’re aware.
Paul: Yes.
Patrik: And do you know, have they isolated the infection?
Paul: I think it’s the lungs that they are treating.
Patrik: Oka and have they found a specific bug?
Paul: I don’t believe so. No.
Patrik: Okay. Cause I think that would be important. You know, they’re giving him probably a broad spectrum antibiotic, most likely.
Paul: They said that it was targeted for the infection.
Patrik: Okay. So they must’ve found, okay. They must’ve found the bug then. Okay. do you have any blood results?
Paul: I don’t, but I can ask her.
Patrik: Okay. All right. So blood results to look for is hemoglobin. I’ll write it down. White cell count. Probably CRP and also potassium and magnesium. And do you know if the kidneys are working?
Paul: I believe they are. As of yesterday, they were.
Patrik: Okay.
Paul: And that his urine is pretty dark though.
Patrik: Say again?
Paul: So my dad’s urine is pretty dark.
Patrik: Right? Okay. It could be, it could be dehydrated.
Paul: Yeah. Do you know? They gave him Lasix the other day, sort of helped the lung infection, but now he’s getting fluid.
Patrik: Did you say earlier he was getting a 125ml an hour.
Paul: No, that’s how much food he was getting? No, he was only getting 25 milliliters of food through the PEG.
Patrik: Right. Okay. Okay. And is he being fed at the moment?
Paul: No.
Patrik: Right. Okay.
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Paul: And the nurse explained this, that actually might be an issue because they said that the way that he is right now with his ability to process gas and diffuse oxygen dropped the body is any good. They would most likely not be absorbed, right?
Patrik: Yeah. Well that may be the case, but if they haven’t tried or then, then it comes back to what I mentioned to you earlier, Paul, about the TPN.
Paul: Yeah. You said they’re going to discuss that today.
Patrik: Okay. That’s good. That’s good.
Paul: Or at least the main line, not the TPN, but doing a main line. Okay.
Patrik: So do you think that your dad is comfortable?
Paul: I don’t think he’s conscious, so I don’t know how to answer that other than I don’t think he’s conscious.
Patrik: Right. Do you feel like he’s in any pain or discomfort?
Paul: Hey dad, can you wake up for me? Yeah. Are you there? Okay. No, I mean, I don’t think..
Patrik: Is he not distressed?
Paul: No. Okay.
Patrik: He’s not, he’s not gasping for air?
Paul: No. I mean, you can take a look at it and we want to see him again.
Patrik: Yeah. If you’re happy with that,
Paul: Okay here you go.
Patrik: Yeah. He doesn’t look in distress. He looks incredibly pale. Could be the lighting as well.
Paul: I’m sorry.
Patrik: Lighting. But he looks incredibly pale from my end.
Paul: Yeah. Well the saturation’s only 85% and his blood pressure is 127 over 44.
Patrik: How often do they check that?
Paul: The blood pressure. Yeah. It’s every 15 minutes. It’s an automatic one. Okay.
Patrik: Every 15. Okay yeah.
Paul: Yeah. I mean you could see it’s on the monitor. Yup. Let me see that. It’s getting better actually than it was, you know, a couple of hours ago.
Patrik: Especially with sepsis and you also want to know the lactate. Can you see what I typed in the chat pad? Okay.
Paul: Yeah. Let me take a look here. I’m not super familiar with using them. Usually I can figure things out. Is it a, is it a function?
Patrik: Yes. So if you go into participants because I’m on an iPad as well, if you go to participants on the right top for now, and then there should be, if you click on my name, there should be a chat.
Paul: Oh, I see it. I’m going to take a picture of this with my phone. Yeah. I just took a picture of it with my phone. So yeah, I don’t know. I mean, I think the comfort care is really warranted at this point,
Patrik: But that’s also why I was asking Paul, your dad is in easy, comfortable, easy in distress. You know, if he’s not in distress, he doesn’t probably need anything else besides the treatment. If he was in distress, absolutely. Give, give him something that makes him comfortable.
Paul: Yeah.
Patrik: I feel like the atrial fibrillation, you know, if they could get that back into a normal heart rhythm that could help, that could help improve your situation.
Paul: Is it common for him to not be coherent or aware at all?
Patrik: I don’t know if he’s, if he has sepsis, it would more or less be unconscious bear in mind, it’s 4:00 AM for you, so he would be asleep anyway.
Paul: Yeah. Just turn on the lights. So let me see if that affected my dad at all, but I think they’re going to take some blood, so.
Patrik: Oh, good. Good.
Paul: You can take a look. If you want to see him in the light. Yup.
Patrik: Well, looks, looks a little bit better. I think it’s skin color looks a little bit better in the light.
Paul: Yeah.
Patrik: I think getting some answers to those questions that I sent you, I think would be very valuable to see what they’re doing. You know, what do the numbers look like? I think it would be very valuable to get some answers there. When you saw your dad in the morning, last morning or in the afternoon, would you say there is a deterioration between the afternoon and now?
Paul: Yeah. Okay.
Patrik: Right. Is it just, just the numbers or is it when you look at your dad?
Paul: When I looked at my dad, he’s not conscious now.
Patrik: And he wasn’t unconscious in the afternoon.
Paul: Yeah. He was conscious then.
Patrik: Bear in mind. It’s 4:00 AM. He might just be asleep.
Paul: Yeah. Also, I don’t know.
Patrik: Oh, I would, if I were you, I would want to know what they’re doing with the atrial fibrillation, with the irregular heart rhythm. I would really want to know if I was you what they’re doing with that, because that, that seems new to me. It’s fast. It’s new, it’s fast and it’s irregular, and irregular heart rhythm is not a good thing.
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Paul : Yeah. His blood pressure is now 143 over 26.
Patrik: Okay. That’s good.
Paul: Alright. You know, all of that, I’ll address all these questions. But it’s hard for them to find out what the saturation is because his blood pressure is so weak.
Patrik: He’s probably cold in his fingers.
Paul: Yeah. He has a cooling blanket, so yeah. Alright. Well I’ll look it up for questions with the nurse.
Patrik: Why don’t you do that? And then call me back. We can get on. We can get back on, but I would really do. I think those questions are really, really important to find out. And why don’t you call me back?
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Paul: I will. Thank you, Patrik.
Patrik: Thank you. Thank you so much.
Paul: Thank you. Bye. Thank you.
Patrik: That’s it. Thank you. Bye bye.
Kind regards,
Patrik
