My 81 year old brother is Septic after foot amputation and not waking up after an induced coma! Help

https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-my-81-year-old-brother-is-septic-after-foot-amputation-and-not-waking-up-after-an-induced-coma-help/

Quick Tip for Families in ICU: My 81 year old brother is Septic after foot amputation and not waking up after an induced coma! Help

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

Today, I’ve got a question from a client that I want to answer. The client’s brother is 81 years of age. Has gone into ICU with a foot amputation, which was completely unexpected. And he ended up with a foot amputation, and then he ended up in sepsis and in septic shock. It’s been about two weeks now that he was in septic shock. He’s been commenced on numerous antibiotics. He was on numerous vasopressors and inotropes. He was very sick. He was in an induced coma. He was on dialysis. So, he had the full-blown septic picture happening to him for the last two weeks. And now, he’s at a stage where he’s more stable and he’s finally coming out of the induced coma.

And the sister’s asking me, “How long will it take for him to wake up? Because he has not shown any signs of waking up at all after those two weeks.” And the answer to it is really that it depends. It depends on how many sedatives was he on? How many opiates was he on over the last couple of weeks? What was the quantity of that? Has he had a neurological event? Has he had a stroke during this period? Has he had any seizures? According to the sister, her brother hasn’t got any significant premedical history. He was previously fit and healthy, and this came out of nowhere. And last but not least, it also takes time to wake up after a prolonged critical illness. Even though the sedatives and the opiates might have worn off, it simply means the body is not ready to wake up because it’s just a massive shock to the system.

So, the advice here is to be patient, to do a CT (Computed Tomography) scan of the brain, making sure there’s no neurological event. Continuing to work on the kidney failure, if dialysis is needed to clear the system of opiates and sedatives, that’s another way to look at it. Another way to deal with it is potentially to give some antidotes for morphine or fentanyl or also some antidotes for midazolam or Versed to deal with the sedation and opiates in the system quicker and hopefully speed up the waking up process.

Now, if all of that fails, of course, the next step would probably be to do a tracheostomy to give him time. Other things that can be done are obviously physical therapy, sitting him up, stimulating him, talking to him, giving him good basic nursing care, regular washes, regular mouth care, regular turns, making sure there’s no pressure sores, and so forth. And that should help as well but be patient. If all of that fails, of course, a tracheostomy might be the next step to give him more time to wake up as he won’t be able to stay on the breathing tube forever.

That is my quick tip for today.

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