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Dr. David
Dr. David, Board Certified Physician
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Mom is in ICU with the result of improper dysphagia

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Mom is in ICU with the result of improper dysphagia management. She had trouble breathing because of the secretions and was intubated Tuesday in the ER. Since then the IVU has weaned her twice and extubated. They she does fine for about half a day before
suffering an event that requires reintubation. It is unclear whether it is a sudden onset of thick secretions coming up that she is not strong enough to dislodge on her own or more of a case of inflammation. They do apparently suction her out but maybe not
effectively. So, she goes for 5-8 hours off the vent just fine, with or without oxygen, and then suddenly becomes hypoxic. I would assume steroids for airway inflammation and mucus thinners, as she is used to with her home nebulizer, for secretions. We do
not know if either of these remedies has been tried or when. They seem to just see if she's going to be fine. That's not happening. How can this critical juncture post-extubation be eased? At 92, she is not a high priority and the doc seems to want us to allow
her to suffocate next time. She was alert and participatory, mostly. This last time she may have been too dopey to cough, even, which is always weak. What might improve her chances of succeeding longer than a day with extubation? Something seems to be missing
in her post treatment or pre weaning. The bacerial test came back negative. It's probably thick secretions that suddenly manifest after a certain period post-extubation. Any educated guess as to point of origin, cause (irritation?), remedy? Going there soon.
Doc hard to talk to, very dismissive, changes story a lot, and she seems very overworked. Short staffed. Long days. Holiday weekend. Nurses say one thing; doc another. Nurse said yes they suctioned out a hunk of mucus the first time, doc says she did a bronchial
wash and that was what came up. Second time, nurses also suctioned. Nebulizer applied, but we don't know when. She tends toward very sticky thick mucus after aspirating thin liquids. Night aides lax, give her something to drink lying down in bed at night.
That does it. Also they made the nebulizer on demand, so they don't have to tend her so much. It was every 6 hours. She does fine feeding herself puréed food and having thickened liquids, often by spoon.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
This is Dr. David
she needs a barium swallow study to see if she is aspirating liquids
I bet she is having her pureed foods or thickened liquids go down into her lungs. she might need a PEG tube for enteric feedings if she is having bad aspiration
I'm sure she is on an PPI stomach acid blocker
she can benefit from scopolamine patch to help thin secretions.
her wishes have to be honored as well. She might not want to continue to have this intubation extubation business.
does she have a living will or advanced directives?
has she made her wishes know if her heart stops beating or if she stops breathing, does she want to be intubated again?