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
What’s the difference between an induced coma and
sedation?
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 another question that we get quite regularly from our readers and the question this week is
My 54 year old husband went into cardiac arrest and
he sustained an anoxic brain injury! At first he wasn't "waking up" but now he’s improving, what is next?
This email from Tammy is an excerpt of email counselling and consulting sessions with
me!
Hi Patrik,
my 54 year old husband went into cardiac arrest on October 16 and
he has sustained an Anoxic brain injury.
The amount of time without oxygen is unknown. The MRI showed brain damage on both sides.
I have fought hard with the acute care hospital here in Las Vegas, NV to continue treating him and give him the best chance of recovery!
I was really shocked and in horror to find that the ICU team
was so negative and that they pretty much said from the start “if your husband does survive, he won’t have any quality of life”!
My husband started responding once they started lowering the sedation.
But they failed to report it as the hospital he was transferred from reported he would not survive or come out of vegetative state.
He
started responding to me 3 weeks after he had the cardiac arrest and after he went down at home.
I finally got our Patient advocate from the
insurance company involved as I have sent progress videos to them when he started responding.
He now talks with a capped tracheostomy, even though some words are hard to understand.
He’s been off the ventilator for a few days and the Intensive Care team is telling me that he won’t have the tracheostomy out because he can’t swallow. He also needs frequent suction during
the day via the tracheostomy for his sputum and saliva.
He moves all extremities, he follows commands, responds, says sentences, comprehends, his personality has not changed as far as I can
tell.
After more than four weeks in ICU they haven’t gotten him out of bed yet and they are telling me that "he's too weak" still.
I really want them to start trying because I think it’ll be good for him to start getting out of bed sooner than later.
But getting him moved out of Intensive Care into a good facility is also on my mind
and it proves to be a challenge, yet alone getting him physical rehabilitation. Do you have any suggestions and what do you think I should be doing next?
Much appreciated,
Tammy
Hi Tammy,
thanks for sending your question through and thanks for using
my 1:1 email counselling and consulting services.
I'm very sorry to hear what you are currently experiencing with your husband after cardiac arrest and anoxic brain injury.
From what I can tell so far just by reading your emails, you are your husband's best advocate and you have done instinctively what most families of critically ill Patients in Intensive Care are not prepared or are scared to do.
Most families in Intensive Care are too scared and afraid to stand up for what they believe in and they are too scared and intimidated by the “perceived power” and the “perceived authority” of the
Intensive Care team!
You have stood up for him even though the hospital in Las Vegas reported that "he wouldn't survive or come out of a vegetative state."
Good for you to be standing your ground and support your husband irrespective of what the "experts" have told you. You should be giving yourself a tap on your shoulder just by doing that!
Over the nearly two decades that I worked in Intensive Care, I have seen many similar situations that your husband is currently in.
Without your advocacy, the Intensive Care team would have probably tried to "sell" you on a "withdrawal of treatment", a "limitation of treatment", a "DNR" (Do not resuscitate) order or an "NFR" (Not for resuscitation) order or on all of the above, early on.(They may have tried
anyway...)
Next, as I mentioned before I have lots of experience with situations where critically ill Patients "don't wake up" after head/brain injuries or after hypoxic brain injury. I have also consulted many families of critically ill Patients in Intensive Care via Skype or over the phone in similar situations.
My experience has clearly shown me that time and patience is the ultimate healer when it comes to head/brain injuries, including
hypoxic brain injuries. It's a good sign that your husband is talking and is waking up.
That is very different from the “doom and gloom” and the negativity that you have experienced early on from the Intensive Care team when he was first diagnosed with the anoxic brain injury after the cardiac arrest.
It’s great to see that your husband went from “he would not survive or come out of
vegetative state” to “if your husband does survive, he won’t have any quality of life” and now he’s talking, responding, moving all limbs, following commands and comprehending!
Imagine you wouldn’t have standing your ground and fought for his best care and treatment!
Well done for being so strong and for not giving in and fighting for what you knew was the right thing to
do!
It’s good that your husband is now off the ventilator and it’s good to see that he can manage on the tracheostomy, even though he can’t swallow yet.
In order to manage the tracheostomy, your husband should be referred on to speech therapy and a speech pathologist.
They can try and improve his speech as well as his swallowing,
increasing chances to get his tracheostomy removed.
You've mentioned that it is challenging getting your husband on to rehabilitation. Why do you think it is challenging? Is it people's attitude? Is it difficult to find a suitable place? Is it a funding issue? If you could please elaborate on this then I should be able to help you and point you in the right direction.
You should be looking
at neuro-rehab, because clearly your husband’s recovery is brain related. You may have to get back to your health insurance and find out what they recommend and also what they will fund.
Here are is also a link to an article/ video that will explain
I have also had a client a couple of years' back who enquired about her Dad being in a similar situation.
You can check out Laura's questions here
One EBook that comes with two Videos and two audio recordings is tailor made for your situation.
It'll answer most and probably all of your questions in your situation.
You can check it out here
But also as a first step, the ICU where your husband is currently at needs to start mobilising your husband and he needs to start getting out of bed rather sooner than later.
This would also tie right in with your requests for Physical therapy or Physiotherapy.
That would be priority as far as I can see. It would be
very important to have your husband “stress tested” so to speak by gradually moving him into a chair and getting him to sit up.
It would strengthen him and it would help stimulate his brain as well if he was to get out of bed regularly.
Just start asking for it. You have achieved so much and by you pushing for things you have most likely saved your husband’s life and therefore you should be
proud of you!
Rehabilitation as a next step would be great and in order to get him to Rehab, he needs to have been started on some Physical therapy regime whilst still being in ICU, he can’t go from 0 to 100.
Another option that you may want to consider are things like home care services, especially if the tracheostomy can’t be removed.
Services like INTENSIVE CARE AT HOME can provide tracheostomy care at home and they can help you with Physical therapy as well!
Therefore, your next steps are
- Get your husband out of bed and get the ICU to start Physical therapy and Physiotherapy
- Find out from your health insurance what rehabilitation they would fund and also recommend
- Check out services like INTENSIVE CARE AT HOME for tracheostomy care at home
Let me know how you go with this and get back to me if I can be of further help.
Wishing you and your family all the best
