Quick tip for families in Intensive Care: If someone is not waking up after open heart surgery...

https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-if-someone-is-not-waking-up-after-open-heart-surgery/

Quick tip for families in Intensive Care: If someone is not waking up after open heart surgery not responding to anything but is now responding to pain nothing else. Could that be involuntary movement or acutely her doing it

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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, Petra is writing in, she says, “My mom had open heart surgery, and she’s still in an induced coma, and she hasn’t woken up after a couple of days. The only thing is, she’s now slowly responding to pain. Is that involuntary movement or is that actually her doing it?” That’s a great question to ask Petra and let’s break this down for you.

So, someone after open heart surgery should ideally come out of the induced coma reasonably quickly within 24 to 48 hours. Sedation should be weaned off as long as there’s no bleeding, as long as there’s no arrhythmias, as long as there’s no inotropes or vasodilators. It should be reasonably straightforward, assuming it was elective or planned surgery, and it wasn’t emergency surgery. You haven’t elaborated on that, and you haven’t elaborated on any complications that have occurred besides her still being in an induced coma after 48 hours. Sort of the standard approach in ICU for someone after open heart surgery is, “Wake and wean”. Wake them up, wean them off the ventilator, move them onto a hospital ward, that is the ideal scenario. Most of those patients are actually on a pathway, meaning the pathway says, “Day one: ICU, day two: back to a hospital ward”, but that’s not the case in your mom’s situation.

It keeps coming back to that the biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care.

So, let’s look at your situation, what’s happening? So, let’s assume there have been some complications, whether it was bleeding, whether it’s arrhythmia, whether it’s an increased demand on inotropes or vasopressors or vasodilators, whether there’s bleeding, or pneumothorax. There could be all sorts of complications that have happened after cardiac surgery. Let’s just assume that’s the case. So, they probably have to keep your mom in an induced coma for longer. Now, if they have taken off sedation already and she’s not waking up, that’s definitely a concern. And if that is the case, they probably need to do a CT (computed tomography) scan of the brain or an MRI (magnetic resonance imaging) scan of the brain to rule out a neurological event, such as a stroke or any seizures, that would probably be next.

Now, if she’s responding to pain, it just means she’s responding to pain. It’s very hard to say whether that’s involuntary or whether it’s voluntary, whether she can hear you. Probably, she can hear you, but she can’t respond to you. So, it’s really hard to say. A lot of it depends as well on what sedation is she on? What opiates is she on? Again, the bigger picture here matters greatly before you can make any recommendations or jump to any conclusions. It’s like piecing together a puzzle. What sometimes also happens after open heart surgery, God forbid, you might have had a heart attack again. Maybe let’s check a troponin, let’s do a 12-lead ECG (electrocardiogram), do all the tests. There are so many things that could go wrong.

Continue reading at: https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-if-someone-is-not-waking-up-after-open-heart-surgery/