58 year old Dad isn't waking up after cardiac arrest and ICU wants to withdraw treatment, help!

https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-58-year-old-dad-isnt-waking-up-after-cardiac-arrest-and-icu-wants-to-withdraw-treatment-help/

Quick Tip for Families in ICU: 58 year old Dad isn't waking up after cardiac arrest and ICU wants to withdraw treatment, help!

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

So, I’m talking to this client at the moment who has their 58-year-old dad in ICU after cardiac arrest about 10 days ago. And her father is not waking up after the induced coma. They’re now lowering the sedation, but he’s not waking up even though he’s sort of slowly taking steps towards coming off the ventilator. Now, here are some questions that she asked me, and I want to go through them in this video.

So, she’s asking me, “As trembling or shaking is one of the side effects of phenytoin, what evidence is there to show this is not the case?” Now, let me just elaborate on that. When someone had a cardiac arrest and had, potentially, hypoxic brain injury, there’s always the risk of seizures. And phenytoin is simply a prophylactic medication that’s being given to prevent seizures after hypoxic/anoxic brain injury, which is the case in her dad’s situation. Other medications that can be given to prevent seizures are Keppra. In this case, they’re obviously giving phenytoin.

Now, what I can tell you from experience is that after cardiac arrest, a lot of patients are trembling or shaking also called jerking movements. And it’s hard to distinguish whether they are seizures or just other signs of the hypoxic or anoxic brain injury. I don’t know whether there is any evidence that phenytoin is causing shaking or trembling. I think it’s probably the seizures causing shaking or trembling. I think, if anything, maybe they need to increase the phenytoin, but then a lot of it depends also on what else is your dad on or was he on? Like, for example, was he on propofol? Was he on midazolam? Is he still on any of those medications? Is he still on fentanyl or morphine? Because they could take away the edge from the trembling as well. It could be as simple as that he’s waking up slowly because sedation has been completely switched off, which is what you’re telling me is probably the case.

Let’s get on with your questions, “Before he was put on this medication, phenytoin, he was a lot more stable, but since the medication has started, he deteriorated. This suggests the medication is not right for him?” Now, it doesn’t necessarily suggest that. It really depends what other medications he’s on as well. Is his heart stable? Is he on inotropes? Is he on vasopressors? So, it all depends on that as well.

Next, “What evidence does the ICU team have to show? He will not recover, especially after the progress he has shown over the last few days.” Well, I guess that’s where the rubber hits the road. There is no evidence that he’s not making any progress. I mean, it’s 10 days in ICU, it’s not 10 weeks in ICU. As you’ve heard me say over and over again, they’re trying to be in control of the narrative. And they’re trying to talk you out of a recovery of your dad and the recovery for your dad will need to take time, but we need to take time. But we will come more to that in a moment.

Continue reading at: https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-58-year-old-dad-isnt-waking-up-after-cardiac-arrest-and-icu-wants-to-withdraw-treatment-help/