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 last week was

My son’s father had a heart attack and is not waking up in Intensive Care after cooling therapy! Please help!

You can check out the answer to last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer question from one of our readers and the question this week is

My husband is in Intensive Care with Pancreatitis and liver failure! He’s on a ventilator, in an induced coma and he’s bleeding! Help!

This question from Lisa formed part of an email consulting/counselling session with me.

Lisa writes

Hi Patrik,

my 57 year old husband is in Intensive Care with Pancreatitis and liver failure, due to him being a heavy drinker.

He is on a ventilator, in an induced coma and he’s got internal bleeding from his stomach and he has been vomiting blood!

They have been giving him numerous blood transfusions!

The Intensive Care team has been very vague about his prognosis and they are trying to avoid answering my questions!

I am very worried that he may die and I am extremely scared about the future!

Can you please shed some light on this difficult situation and tell me what I should be doing?

Thank you

Lisa

Hi Lisa,

thank you for sending through your question and thank you for signing up for email consulting with me.

Firstly, the situation your husband is in is not an unusual situation when being admitted to Intensive Care for chronic alcohol abuse with liver failure and Pancreatitis. I have seen it over and over again.

Let me explain.

Liver failure and Pancreatitis often go hand in hand after chronic alcohol abuse.

Whenever the liver is affected, the blood clotting mechanisms usually get out of order pretty quickly and therefore, critically ill Patients in liver failure are at high risk of bleeding.

Hence the stomach bleeding is not a surprise by any means it’s often what happens. On top of that your husband’s natural stomach content and flora would have most likely been imbalanced prior to hospital admission due to the drinking.

Giving blood products is the right thing to do in order to get your husband through this critical stage and keeping him alive.

On top of that they will most likely have started him on Inotropes(=Intravenous infusions to maintain a decent blood pressure) as with all the bleeding he would have lost significant amounts of blood volume and therefore his blood pressure would have dropped significantly to critically low levels.

The Intensive Care team should have been able to wean down or even off some of the Inotropes as they were replacing the lost blood with blood transfusions.

Furthermore, in order to also treat the stomach bleeding, they most likely would have started your husband on a Pantoprazole(Somac) infusion, or at the very least give your husband high doses of Pantoprazole intravenously two or three times a day.

Pantoprazole is a proton pump inhibitor that decreases the amount of acid produced in the stomach. The more acid in the stomach, the higher risk there is for a stomach bleed to occur which is highly risky.

The next thing you need to investigate is why your husband has Pancreatitis. There is a high chance that your husband’s chronic alcohol abuse is directly causing the Pancreatitis instead of gall stones. Sometimes gall stones(cholelithiasis) may cause the Pancreatitis however this is unlikely to be the case in your husband’s situation.

It doesn’t surprise me that the Intensive Care team is vague and is trying to avoid answering your questions.

Not only are many Intensive Care Units and their teams poor communicators when it comes to talking to families in Intensive Care, furthermore they usually have their own agenda and simply they are rather busy.

However one issue that I’ve also found in more than 15 years Intensive Care nursing in three different countries, where I’ve literally worked with thousands of critically ill Patients and their families and where I have also worked as a Nurse Unit manager for more than 5 years, is that families in Intensive Care just simply don’t know what questions they should ask and they don’t know where to start.

They also don’t know how to position themselves and their critically ill loved one in order to get the best possible outcome for their loved one. In essence they simply don’t know how to negotiate and bargain for the best possible care and treatment for their critically ill loved one.

They put blind faith into the Intensive Care team without realizing that there are so many things happening “Behind the scenes” in Intensive Care that directly affect how the Intensive Care team is communicating with you, with your family and with your critically ill loved one.

A quick example, if the Intensive Care unit is experiencing a very busy period with huge demand on their scarce, precious and expensive Intensive Care beds, the Intensive Care team may decide to suggest to you and your family that a “withdrawal of treatment”, a “limitation of treatment” or that a ”DNR”(Do not resuscitate) or an “NFR”(Not for resuscitation) order could be in the “in the best interest” for your critically ill loved one.

Related:

THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO “LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT” OR “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR AN “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!

If that’s the case you and your family need to decide whether you are prepared to negotiate along those lines or not. You have choice the minute you have decided that you are the one in charge of your own destiny.

The fact of the matter is that you need to be in a position to make informed decisions, get peace of mind, control, power and influence quickly, because otherwise you, your family and your husband might be in a position where the Intensive Care team is making decisions for you that you are not comfortable with.

You need to very quickly educate yourself, get a crash course on what’s really happening in Intensive Care and put yourself in a strong position to get the outcomes for yourself and for your husband that you want and deserve.

You need to be in charge of your own destiny and nobody else.

Given that your husband is in an induced coma and on a ventilator he might face an uphill battle of being weaned off the ventilator. The reason being is that my experience with liver failure and pancreatitis, induced coma and ventilation is that critically ill Patients in that situation are even more fragile and vulnerable compared to other critically ill Patients.

Generally speaking critically ill Patients with liver failure and Pancreatitis tend to be malnourished and have very few reserves to draw upon.

Recommended:

• Email counselling/consulting with Patrik

• One on One phone/ Skype counselling/consulting with Patrik

Therefore it is often difficult to wean them off the ventilator and get them out of the induced coma. Because of their primary liver and pancreas issues some of the medications for the induced coma are not being metabolized properly and therefore "waking up" after an induced coma can even take longer.

Because critically ill Patients with Liver failure and Pancreatitis often have bleeding issues, their general condition is not the best to deal with a critical illness.

Having said that, time and patience is often the essence in Intensive Care and being patient helps to master this challenge.

But you need to also start asking the right questions, assert yourself and make sure you make informed decisions, get peace of mind, control, power and influence.

Wishing you and your family all the very best.

Patrik