	AllExperts > ICU/Critical Care
	Search

About Wesley
Expertise
I can translate the jargon and answer the complex emotional and medical questions related to an ICU stay. I am a constant student of the changing face of Medicine, and hopefully I can help you come to a better understanding about what you can expect during your stressful time. I find that once the language is explained a little clearer, the puzzle comes more into focus. Usually, just to know that you are not alone may help. I am familar with all facets of critical care except transplant and neonatal care. Questions about Sepsis, ventilation, gall bladders, hemodialysis, complicated cancer surgery and alcohol withdrawal, suicide/overdose attempts are welcome. Students are welcome

Experience
12 years as an ICU nurse and 2 yrs on Neurosurgery. Mentor, teacher, been there in your shoes myself.

Education/Credentials
BSN from Clemson, 15yrs grunt medic in the ARMY.

You are here: Experts > Health/Fitness > Medical Specialists > ICU/Critical Care > Father

ICU/Critical Care - Father

Expert: Wesley - 11/4/2009

Question
QUESTION: my father is 80 years old. Diabetic, Heart problems, altimers, high blood pressure etc....   Fell out of bed in mid sept. 2009. finally went for cat scan after 2 weeks and shortness of breath.
Went in Hospital Oct 1st 2009 for small procedure with needle in his back to drain the fluid (blood) out of his lung. Aslo had fractured ribs. The docs only got some of the fluid but dad caught some kind of bacteria infection. HUMMMM   Anyway barely passed the stress test for the vats surgery. A two hour surgery lasted 7 1/2 hours. Surgery was a sucess but they had to peel away major scar tissue to get to the fluid. 1 week intubated and asleep. No one was saying anything at that point. Then they gave him a treac and feeding tube in his belly. After two weeks woke up/mri of brain and was o.k. They are having a hard time trying to wean dad off the traec. still in icu. I know they want to send him to a long care weaning vent place sometime soon but no one is saying when as of yet. I am devistated and docs won't give me an honest answer as to if my dad will stay like this or not. visit every day in hopes he gets off this traec but at this point I'm not hopeful. Docs keep saying that they didn't expect this. Any advice at this point will help. Sooo upset and looking for some light at the end of the tunnel but after reading so much stuff on the internet, it seems that my dad don't have much time.

ANSWER: Joan I'm sorry you're having to face such a hard time.

First, blood in the chest is infection so long after a fall. If he is not able to express himself well normally, the pain he was in at the time could have been missed. This leads to lack of pain control which leads to shallow breathing which leads to pneumonia.

Weaning from the vent takes time. He was not young nor healthy before and this was a big surgery. He should be able to wean if given the chance, so be patient. Often the doctors in a situation like this will truly not know what the person is capable of until well into the hospital stay. The surgery is very painful, this is a key to successful weaning. This could be a pint to inquire about.

He can do it, small steps are still steps.

---------- FOLLOW-UP ----------

QUESTION: I need you to clarify something for me from your answer. I'm not sure what you meant when you said that the painful surgery is a key to successful weaning. Not sure what to inquire about. Also, dad has been on the vent and weaning on the pressure support of 14 and sometimes 12 for long periods of time. Went to visit a Long term facility that weans off traec's. They said that they will try for 25 to 30 days and if weanable, then my father would be sent to a more aggressive rehab. If not, we have to start looking into nursing home care or ask dad what he prefers and this place said we should honor our dad's wishes... Wow alot to take in today and not quite sure how to handle that. Docs say it is hard to wean off a traec with copd dad has that also along with the tough surgery he already had. Every doctor has said that this surgery took alot out of my father but I still have no idea how hard this surgery actually was.

Dad was awake today sitting up in a chair and coherent. Keeps asking for something to drink and I know he can only be swabbed with water. Not such a great life.   ICU docs are now saying to try and find a place for dad because the longer he stays in ICU, the more chance of infection he can develope being there. Mom is beside herself and doesn't want to leave the hospital because they are taking such good care of dad. Starting to think that they just want him out because of insurance reasons. They say he is medically stable and needs to leave within the next two weeks.

Answer
Actually it looks like the answer was cut, which happens in the input interface as I type sometimes. Sorry.

What I said was the surgery is painful and controlling the pain is hard to do in people who fail to express it well, however this is a key to the success of the surgery.

Let's explain what we're talking about with the surgery. In a case where the person has had a trauma, like a fall, several things happen. The rib can break, the lung gets bruised, the airway under the injury is compromised due to swelling, pneumonia sets in. Then the infection causes fluid to begin to collect inside and outside the lung. In the void where the bruise was the healing process forms a 'rind' that contracts that portion of the lung causing poor breathing. And it builds and gets worse as time goes on. The surgery to remove the 'rind' of scar, infection and scabby stuff from the lung can mostly be done with a camera and pinchers. However, if it is too tough or involved or wrapped around too much lung it has to be converted to a open procedure. An incision. This interrupts the continuous muscle envelope of the chest, cuts through sensitive nerve tissue and limits the bodies natural chest expansion. But its curative. We're not talking about grade 4 lung cancer. He can get over this.

Things to inquire about:

A gerontologist should be managing his sedation meds. His mental condition is complicated and he needs the expertise of these specialist.

He needs continuous pain control not 'as needed' meds. A patch, a pump or some form of smooth control of his pain. Without this he is going to be unable to manage off the vent, to do breathing exercises or to sit and do nothing at all. Again this is a key point to the success of this surgery overall.

Moving is a positive thing. A LTACH (long term acute care hospital)is the place for him now. We have our own, transferring is a small matter of paperwork. I know that it is not this easy everywhere. These hospitals should be personal and very open to questions. There are 'day limits' in terms of insurance that he would not want to break while in the hospital, this is the source of the '2 weeks' talk. If over this limit at a certain point he will be hard to place anywhere. A good social worker should be able to help you with this.

Add to this Answer Ask a Question