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After Many Months in ICU After Subarachnoid Hemorrhage, Seizures & Tracheostomy, A Patient Can Go Home
Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home, and where we also provide tailor-made solutions for hospitals and intensive care units at home whilst providing quality care for long-term ventilated adults and children with tracheostomies at home, otherwise medically complex adults and children at home, which includes Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), home tracheostomy care for adults and children that are not ventilated, Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions, as well as home IV antibiotics. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, as well as Hickman’s line management, and we also provide palliative care services at home.
We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully for the Western Sydney Local Area Health District, their in-touch program, saving $2,000 per ED bypass service. Basically, we send critical care nurses into the home for either ICU or ED.
Now today, I want to focus once again on conditions that we can actually look after in the community. Today, I want to just read out the discharge summary from a patient that has been discharged to Intensive Care at Home. So, here’s the discharge summary,
“Critical Care Medicine Discharge Summary
74-year-old female on the 31st of August 2024 with past medical history of aneurysmal subarachnoid hemorrhage, hyperthyroidism, lupus, CABG (Coronary artery bypass grafting), non-Hodgkin’s lymphoma, hypertension, chronic kidney disease who presented to ED with seizure like activity. Patient family given her 4 mg of Lorazepam inadvertently, although 2 mg of Lorazepam was prescribed which resulted in respiratory arrest and patient transferred to the emergency department requiring bag mask ventilation.
Reportedly, patient had been recommended hospice care at the hospital, but it has not been established as family wanted to continue with her management at home with home health such as Intensive Care at Home.
She has extensive neurological history at the hospital where she was initially admitted in March 2024 which included subarachnoid hemorrhage secondary to right MCA (Middle Cerebral Artery) aneurysm and VP (Ventriculoperitoneal) shunt placement. Patient was discharged to inpatient rehab and presented back in July 2024 for sepsis and malfunctioning VP shunt which was reportedly removed. However, it’s visible on the current CT scan.
The patient developed subdural hematoma requiring surgical evacuation. On August the 9th, the patient experienced generalized tonic-clonic seizures and was readmitted back to ICU for a couple of weeks. She was discharged and bounced back to ICU straight away on Depakote and Vimpat, but she was not able to fill the prescription for Brivaracetam.
Presented back to ICU on the 31st of August requiring ventilation support. Antiseizure medication adjusted with continuous EEG (Electroencephalograph). Currently off. Tested positive for C. diff and supplied with adequate treatment.
The seizures and the intracranial insult were followed by pneumonia process which was adequately treated. Her seizure has been adequately controlled with multiple antiseizure regimen as above. Repeat chest X-ray on the 1st of October showed no acute cardiopulmonary process.
She is able to successfully wean off ventilation support as of the 2nd of October 2024. Stable for discharge on the 14th of October 2024.
Active hospital problems
Diagnosis:
- Palliative care encounter
- Medically complex patient
- Advanced care planning
- Acute on chronic respiratory failure
- Seizures
- History of subarachnoid hemorrhage
- Coronary atherosclerotic disease
- Hyperthyroidism
- diff infection
Resolved hospital problems
- No resolved problems to display.
So, then the report continues,
- Subarachnoid hemorrhage
- Acute respiratory failure: tracheostomy with increased secretion. I think the secretion is likely from her tracheostomy and not lower respiration tract.
Patient appears stable without antibiotics, and we continue to monitor patient off antibiotics at this time.
So, received patient from night shift on the following settings. Patient is on room air, patient has a 6.0 Bivona cuffed tracheostomy with an artificial nose for humidification.
No acute distress overall, frail in tracheostomy, obese habitus, reclining in bed, head of bed fairly raised, low burden of respiratory secretions observed. No dyspnea, tongue is not protruding.
No twitching of face, extremities, no nystagmoid eye movements, no protruding of tongue seen even with stimulation.
Eyes closed at rest, but with sternal rub did open and that was fairly sustained. There are no orienting eye movements. No following commands, some spontaneous movements in the mouth and jaw, made no spontaneous movements of the extremities, no roving eye movements seen.
Not blinking to threat on either side. Pupils are 5 millimeters with small reactivity too. Its present corneal reflex, no gaze preference, no facial weakness, positive doll’s eyes.
Some increased tone in all extremities. Left upper extremity movement to pinch appear as decorticate posturing but smaller than previous. Right upper extremity movement to pinch small but great and nonspecific. Right lower extremity and small movement to pinch, and so forth.
Seizures
Active Problems:
- Acute and chronic respiratory failure
- History of subarachnoid hemorrhage
- CAD (Coronary Artery Disease)
- Hyperthyroidism
- diff
- Palliative care encounter
- Medically complex patients
- Advanced care planning
ABG or arterial blood gas showed the PCO2 (Carbon dioxide) of 35 and that is actually normal. No motor activity or other manifestations be concerned for seizure since yesterday. Has some eye opening despite increased Topamax.
Discharged with current anticonvulsants, including Topamax at 200 mg BID for review.
Diastat to be available for significant seizure manifestation per seizure action plan. Dose would be 13 mg via 20 mg applicator. Other instructions to be given about documentation of possible seizure manifestations will be refined over time.
For spell of tongue protruding, limb twitching, facial twitching lasting less than 5 minutes, patients should have any stimulation decreased, lights off, quiet, should be documented in seizure log, and should be called to neurology clinic to report.
For a spell of tongue protruding, limb twitching, facial twitching, lasting greater than 5 minutes, the on-call Mercy should be called, the patient should be continued with close monitoring of vitals.”
That’s all not necessary with Intensive Care at Home but I’m just reading out the discharge summary here.
So now, you can actually see what is possible at home when you have the critical care nurses at home, 24 hours a day. Situations like that can be managed at home easily.
So, with Intensive Care at Home, we’re currently operating all around Australia in all major capital cities, in all regional and rural areas. We are an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, NIISQ (National Injury Insurance Scheme in Queensland), and iCare in New South Wales. We’ve also received funding through public hospitals, departments of health, private health funds. There’s funding avenues available.
Now, we are the only service provider in Australia in 2024 that has achieved third-party accreditation for Intensive Care at Home nursing. No other provider has created this much intellectual property for Intensive Care at Home nursing than we have. We are therefore employing hundreds of years of intensive care nursing experience in the community combined. Once again, no other provider brings this level of expertise into the community than we do.
Like I said, if you’re at home already, and you realize that you’re on a ventilator, tracheostomy, BIPAP, CPAP, Home TPN, whatever the case may be, and you realize that your current setup is not working and is even dangerous and that your current team is not having the skills and expertise you need to keep you at home predictably, you feel unsafe, or you’re going back to ICU all the time, or you’re going back to hospital all the time, then you should reach out to us urgently at intensivecareathome.com.
We have turned around many of our clients lives by keeping them out of hospital and out of ICU predictably and improving their quality of life at home instantly. Don’t worry about the funding levels because we can help you with the funding otherwise, we would not be in business.
That’s also why we’re providing Level 2 and Level 3 NDIS Support Coordination. Our NDIS Support Coordinator, Amanda Riches have a wealth of knowledge and their team. I’ll put a link in the written version of this blog to an interview that I’ve done with Amanda a while ago. We’re also providing TAC case management and WorkSafe case management in Victoria.
If you’re an NDIS Support Coordinator and you’re watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for more nursing care for your participants and you don’t know how to go about it and what evidence to provide, I also encourage you to reach out to us. We can help you with the advocacy and we also provide NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.
If you’re a critical care nurse and you’re looking for a career change, we’re currently offering jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, in Albury, Wodonga, and Bendigo in Victoria, as well as in Warragul in Victoria, and in Geelong in Victoria. If you have worked in critical care for a minimum of two years, pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted to hear from you.
I have a disclaimer though because we are offering a tailor-made solution for our clients, which includes regular staff, our clients will have the same staff coming over and over again because they’re so vulnerable and so special. It’s all about building those critical relationships with our clients and with our team members and having regular and stable teams.
That means if you’re looking for agency work where you can come and go, this is probably not the right fit for you on a long-term basis because our clients want regular and the same staff over and over again. So, it’s all about building those critical relationships with our clients and we want to build relationships with you as well, of course, so that it remains a win-win situation.
If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We are currently expanding our medical team as well. We can also help you eliminate your bed blocks in ICU and ED for your long-term patients or for your regularly admitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds and in most cases, you won’t even pay for it.
If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, et cetera, please reach out to us as well. We can help you.
If you’re in the U.S. or in the U.K. and you’re watching this and you need help, we want to hear from you as well. We can help you there privately.
Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].
If you like my videos, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care, click the like button, click the notification bell, share this video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.
Thank you so much for watching.
This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.
Take care for now.