Quick tip for families in ICU: My sibling's in ICU with liver failure&he's deteriorating fast! Help!

https://intensivecarehotline.com/blog/quick-tip-for-families-in-icu-my-siblings-in-icu-with-liver-failure-hes-deteriorating-fast-help/

I have a family member in intensive care at Sheffield northern general hospital he is my sibling and he has liver failure due to poisoning with alcohol and paracetamol they have had him on a ventilator now for 10 days and they say his blood is not clotting and he is starting to bleed from we’re the cannulas are put in to his arm and they are now saying there nothing more they can do for him please can u give us some help and advice as he was alert yesterday and now is fully asleep."

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

Today’s tip is about a question that I want to answer from a reader and the reader writes, “I have a family member in intensive care at Sheffield Northern General Hospital. He’s my sibling and he has liver failure due to poisoning with alcohol and paracetamol. They have had him on a ventilator now for 10 days and they say his blood is not clotting, and he’s starting to bleed from where the cannulas are put into his arm. And they’re now saying there’s nothing more they can do for him. Please, can you give us some help and advice as he was alert yesterday and now, he’s fully asleep.”

Okay, great question to ask and I’ve seen those situations over and over again in intensive care. I’ve worked in intensive care for over 20 years in three different countries. And I have looked after hundreds, potentially thousands of critically ill patients and their families.

So, when someone has liver failure in ICU due to poisoning with alcohol or Panadol, or a combination of both, their blood clotting is often disturbed. Their clotting cascade is often not working, i.e., that’s why they are bleeding. So then, what you’re describing he’s got a central line, probably either in the shoulder or in the jugular there or potentially in the groin. He also probably has an arterial line or an arterial catheter either in the wrist or again, in the groin. And then, if the blood isn’t clotting, if APTT (activated partial thromboplastin time) is off or INR (international normalized ratio) is off, they are blood clotting parameters that you get from blood results, or platelets are low, then they start to bleed.

So, what can be done about that? Potentially, some blood transfusions. Potentially, some platelets can be given. Potentially, some FFPs (Fresh Frozen Plasma) or potentially some red blood cells. So, that is what might need to be done next. Not sure why your brother is, or your sibling is back to sleep. Maybe they put him in an induced coma now. Maybe they thought he was in pain. Maybe they’ve given him some opiates, such as fentanyl or morphine. Maybe they put him on some propofol, or midazolam, or Versed, or maybe on some Precedex. Those are the questions that you need to ask but there’s probably some options that they can do.

And I guess from what I’ve learned over the years, 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. And I guess that’s what you’re facing here that you’re getting a snapshot of what your sibling is dealing with. But the bottom line is this, when someone is in intensive care in a situation like your sibling, there are dozens of things happening simultaneously. And you need to understand and know all of them to really get a good picture. What else is happening here? Is he on a ventilator?

Continue reading at: https://intensivecarehotline.com/blog/quick-tip-for-families-in-icu-my-siblings-in-icu-with-liver-failure-hes-deteriorating-fast-help/