Anesthesia, Resuscitation, and ICU: Q&A

The way things run at JLL is pretty straightforward—the attending physician takes care of everyone on shift. When the next day rolls around, a new doctor takes over and keeps the momentum going. Honestly, that’s how patient care should work. It drives me crazy when people talk about one specific doctor "managing" a critical patient, because then the moment that doctor heads home or the weekend hits, nobody even glances at them. I know from experience that this happens way too often in various wards. By the way, which unit is the patient actually in? In the ICU, the anesthesiologists handle their own percutaneous dilatational tracheotomies (PDT), which is much gentler than the classic ones ENT surgeons do in the OR, so the setup here sounds a bit unusual to me. On the other hand, since they mentioned SIMV and ventilators, it definitely sounds like an ICU placement. The choice of ventilation mode usually comes down to what the attending doctor prefers, but SIMV—being a volume-controlled mode that allows spontaneous breaths—isn't necessarily the most lung-friendly option. Using BiPAP as pressure-controlled ventilation, or combining CPAP with ASB, helps prevent those sky-high pressures that can really mess with the lungs... though I guess we're splitting hairs now. Those numbers you mentioned are definitely trending in the right direction, though. If you can, try to dig into how much the patient is actually doing the breathing themselves (specifically looking at spontaneous minute volume and tidal volume if they're on Draeger Evita machines). If they're hitting a significant percentage there, that's a really great sign. From what I've seen, things often start looking up once the tracheostomy is done. Fingers crossed everything goes smoothly.

As for those guys... regarding the referral... whether they show up or not... honestly, forget it. It doesn't feel like that guy is going to offer much insight anyway. You should really try to push for whether a bypass surgery is being considered and see if you can get a second opinion from a cardiac surgeon. I totally get the whole thing where cardiologists, surgeons, and internists all stay in their own lanes and don't want to step on each other's toes, but if you insist on getting some clarity, at least you'll know you did absolutely everything in your power. Good luck.

Scott Allen10 said:If by "signing off on a procedure" you mean a tracheostomy... then yeah, go for it. A trach really needs to happen if someone’s been on mechanical ventilation for about 10 days and there’s no sign they’re weaning off anytime soon. Honestly, patients find it way easier to get weaned from a ventilator once they have a trach compared to having a tube down their throat.

You should definitely ask what the cardiac surgeon thinks about jumping into emergency surgery. There isn't really much point in trying to "stabilize" a patient if they're truly in this kind of condition. If there's a clear indication for urgent surgery, the patient is classified as critical and they head straight to the OR. Definitely try to hash this out with the surgeon. In my opinion, there's no catch-22 here. The core issue is the heart/the pump, and the lung issues are just a consequence of that weak pump.

Hey there!
Your husband is in really rough shape right now. He’s fighting for his life. The standard playbook would be to focus on hemodynamic stabilization first, getting his breathing stabilized so he can be weaned off the ventilator, moving him over to cardiology, doing a coronary angiogram and follow-up ultrasounds, and then having a cardiology/cardiac surgery consult to make a final call on whether surgery is the move.
Given how things look with him, the anesthesiologist and cardiologist need to assess whether he can even handle a coronary angiogram right now—which, let's be real, is a risky procedure with its own set of complications—and potentially stenting, or deciding if surgery is necessary. Usually, cardiac surgeons won't touch a case without an angiogram to see exactly what's going on with the vessels, and they tend to be pretty cautious about operating on patients this critically ill because the mortality risk is incredibly high.
Because of all that, I'd suggest talking to the anesthesiologists on duty in the ICU and making sure you insist on speaking with the cardiologist examining him. You need them to be crystal clear and give you a decisive plan regarding his next steps. The anesthesiologists will do everything in their power to help him given how critical he is, but at the end of the day, cardiologists are the ones who treat the heart.
Good luck!
Anyway,

urbanscout50 said:Hey there!
Your husband is currently in critical condition—he’s really fighting for his life right now. The standard protocol here would involve stabilizing his hemodynamics first, then focusing on respiratory recovery to get him off the ventilator. Once he's stable, the plan is to move him over to Cardiology for a coronary angiogram and follow-up ultrasounds. From there, the cardiology and cardiothoracic surgical teams will hold a consultation to make a final call on whether surgery is necessary.
Given your husband's current condition, an anesthesiologist and a cardiologist really need to sit down and assess whether he can handle a coronary angiography right now—which, let’s be honest, is a risky procedure with its own set of potential complications—and if following that up with stenting or even full surgery is feasible. Usually, cardiac surgeons won't even consider operating without first seeing the results from an angiography to get a clear picture of the coronary arteries; plus, they tend to be very cautious about stepping in with patients this critical, since the mortality risk is incredibly high.
Based on that, you should try to talk to the anesthesiologists on duty at JLL—and don't be afraid to push for a direct conversation with the cardiologist overseeing his care. You need them to be clear and give you a definitive answer regarding the next steps and the treatment plan for your husband. While the anesthesiologists will certainly do everything in their power to stabilize him given how critical his condition is right now, at the end of the day, the cardiologists are the ones managing the heart.
Good luck!
Anyway—

Scott Allen10 said:The workflow at JLL is pretty straightforward—the attending physician handles all patients during their shift, then hands off to the next doctor the following day. Honestly, that’s the most logical way to manage care. It seems totally irrational to claim a single doctor is "managing" a critically ill patient when, in reality, nobody even checks on them once that doctor heads home or the weekend hits—though I know that happens in plenty of departments. By the way, which specific unit is the patient in? If they are performing percutaneous dilatational tracheotomies (PDT) in the ICU, that's a bit unusual to me—usually, ENT surgeons handle those via traditional methods in the OR, and PDT is generally much gentler. On the other hand, since they're on SIMV and a ventilator, they are definitely in the ICU. Ventilation modes really depend on the preferences of whichever doctor is on duty—but SIMV, being a volume-controlled mode that allows for spontaneous breaths, isn't necessarily the most lung-friendly option. Using BiPAP (pressure control) or combining CPAP with ASB helps prevent those high pressures that can actually damage the lungs... but hey, maybe I'm splitting hairs here. The numbers mentioned are definitely trending in the right direction, though. You should try to find out exactly how much of the work the patient is doing themselves—specifically looking at their spontaneous minute ventilation and tidal volume (or SpontMV and SpontTV if they're using Dräger Evita ventilators). If those numbers show the patient is contributing a significant percentage, that's a great sign. In my experience, things usually start looking up once the tracheotomy is done. Fingers crossed everything goes smoothly.

Regarding those doctors... the referral has been sent, so we'll just have to see if they actually show up—though, honestly, I wouldn't hold my breath—it feels like he isn't going to offer much insight. You should really try to dig deeper and ask if bypass surgery is even being considered—or if it was discussed previously—and somehow find a way to get a second opinion from a cardiac surgeon. These specialists—cardiologists, surgeons, internists—all tend to stay in their own lanes and avoid stepping on each other's toes. I get how those professional circles work, but if you insist on getting some clarity, at least you can tell yourself you did everything humanly possible. Good luck.

First off, thanks to you both for all the advice and explanations

He was seen by the cardiologist—Dr. Vujicic—today, and the anesthesiologist on duty mentioned that based on her orders, we’re sticking with the current therapy for now—still no interventions planned. While glancing at his cardiology report sitting on the bedside table (I was trying to be discreet—they don't allow reading charts!), I caught a few key phrases: "patient in post-cardiogenic shock state" and "recommend continuation of current therapy." Honestly, the whole report might have just been three sentences, and I struggled to make out the handwriting, especially since I was just peeking. What we were most terrified of was that mention of cardiogenic shock—we'd read about it online and the symptoms matched him perfectly, but nobody had actually used that term with us until now. Also, the doctor on duty told us today that the lung imaging hasn't shown much improvement since two days before that last heart attack. I did notice it's the first day he isn't hooked up to a defibrillator, and they've moved him into a semi-upright position for the first time since the infarct. He's currently on 60% oxygen with saturation levels between 91-92%. I signed the consent forms for a tracheostomy; they said it should happen tomorrow or the day after in the OR as part of the ICU protocol, performed by the top ENT team. Regarding the CMV and SIMV settings—he was on CMV today (60% oxygen), whereas yesterday he was on SIMV at 50%, and the doctor mentioned he's contributing about 1.5 liters of his own breath (I'd love some clarification on whether that's a good or bad sign). I didn't catch the specific ventilator model. I'm also trying to coordinate a meeting via phone with one of the cardiologists/cardiac surgeons and Dr. Karanovic. Haven't managed it yet, but I'm hoping to pull it off by Thursday.

Coming back to the cardiogenic shock—does anyone here have experience with this, or know what the typical next steps in treatment look like? And is it true what I read online regarding the mortality rate being around 80%?

Thanks so much

Just jumping in on what Timothy Newman3 said. I just remembered the ventilator model is a Puritan Bennett 7200. Any tips on what we should be watching for, or where to find the tidal volume readings?

Also, a small update from a few days ago: the kidney and urination issues have cleared up, and the swelling in the limbs from fluid retention is gone. It's a little bit of progress, so we're holding onto that and hoping things keep moving in the right direction.

thanks

A tracheotomy was performed—current status follows—though I'm assuming the oxygen concentration is at 70% because of the procedure? I haven't been able to reach the cardiac surgeon directly; I only received word (via his staff) that my husband's condition remains extremely critical. He isn't in any position to undergo surgery right now. His heart has been stabilized through medication, which needs to continue until his overall condition improves and he can breathe on his own—only then can they consider a coronary angiography or anything else. Emergency surgery was only an option immediately following the heart attack; too much time has passed now, so we just have to wait. Phew—it feels like every single day is lasting a month.

Kimberly Young63 said:He’s had a tracheotomy, and this is how things look now—though I’m guessing the oxygen concentration is at 70% because of the procedure. I haven't been able to get through to the cardiac surgeon yet, but they passed along his word: my husband's condition is extremely critical right now. He isn't in any shape for surgery at the moment. They have his heart stabilized with medication for now, and they need to keep him on that until his overall condition improves and he can breathe on his own; only then will they consider a coronary angiogram or anything else. The only window for emergency surgery was immediately after the heart attack, but too much time has passed and we just have to wait. Ugh, honestly, every single day feels like a month.

If that’s what the cardiac surgeon thinks, then it actually makes total sense, and you should at least find some peace of mind knowing you explored that path—especially since the illness went unrecognized and untreated right from the jump. When dealing with a heart this fragile, there are a few ways to help it function while waiting for stabilization, or if things take a turn for the worse: an IABP (intra-aortic balloon pump) is an option, or potentially a VAD (artificial heart). The first one is invasive but a real possibility; the second would mean major surgery in NYC, opening up the chest, which is much less likely. Just stick close to the cardiology team in the coming days. Don't be afraid to keep asking the cardiologists, surgeons, and anesthesiologists about diagnostic options or potential interventions. Be... how do I put this... "persistent." Who cares if they get annoyed? They are there for you and the patient, not the other way around. I know that might sound a bit dramatic, but it really bugs me when medical staff act impatient with people who are already in shock because of a loved one, especially when the hospital rules make getting information feel like being in a prison camp. If you feel like they aren't communicating well... just push back! Things often change for the better once you do. I’ve mentioned before that in my experience, a tracheotomy is usually the best way to start weaning a patient off the ventilator. Since he’s been in the ICU for days, you’re seeing it firsthand—even without being a pro, you can tell you just have to be patient. Try not to spiral thinking about "what ifs"... just take it one day at a time. Don't get too high on the tiny improvements, but don't lose hope if things get complicated, either. Honestly, the fact that he’s still hanging in there after more than two weeks in this state is a huge win in itself.
Spending two weeks in extreme intensive care with mechanical ventilation and in shock carries a massive risk of complications... that’s just the reality of it. Pneumonia, hospital-acquired infections, UTIs—if you haven't seen them yet, expect them. No one in the world has completely wiped out infections, so we certainly haven't; most of the time, these happen not necessarily because of the staff (though that happens), but due to bacteria moving from the digestive tract into the blood, long-term ventilation via tubes and cannulas, and the body's immune system being totally wiped out...
Keeping up with good urine output, providing enteral nutrition through a tube (or by mouth if possible), plenty of physical therapy (turning him, repositioning in bed, massage, percussion), maintaining strict hygiene, and excellent oral care (which is huge), keeping fluids balanced, monitoring hemodynamics (blood pressure, CVP, pulse, cardiac output), using antibiotics as needed, and making sure the airway stays clear (using closed suction systems, gentle ventilation modes, etc.)... I'm just throwing out all the standard stuff they do for critical patients in the ICU. I'm sure that's exactly what's happening with him.

fadedheron14 said:I wanted to jump in and build on what Timothy Newman3 was saying earlier—it just hit me that the ventilator model they're using is a Puritan Bennett 7200. If anyone could point us in the right direction regarding what we should actually be watching for, like how to track tidal volume or things like that...

Also, there’s been a little bit of progress over the last few days: the kidney issues and trouble urinating have cleared up, and that swelling in the limbs from fluid retention is totally gone now. It’s a small win, but it's the kind of positive sign we're clinging to while hoping everything keeps moving in the right direction.

thanks

The PB7200 is a solid, reliable machine, but let's be honest, it's an older model that lacks some of those high-end modern ventilation features. Honestly, if I were you, I wouldn't stress too much about all those shifting numbers on the screen. Seeing something like a 2L contribution doesn't really tell you much because those settings can flip in five minutes flat. You won't be able to put the numbers into any real context, and frankly, they'll probably just end up confusing you more than helping. Now, modes like CMV and SIMV are standard volume-controlled ventilation modes, and I used them for years back in the day. They aren't bad—they get the job done—but they aren't necessarily the most comfortable option for lungs that have been "bruised" by illness and long-term vent support. At least, that's my take on it, though that’s probably a conversation better suited for a specialized medical forum.
But since you brought up the PB7200 and what's going on with your dad... a really encouraging sign regarding his breathing would be seeing the "flow by" and "pressure support" options enabled at the top level, and seeing that green light lit up next to the third option, CPAP, where it shows CMV and SIMV. That would mean the patient is doing a lot of the work themselves, with each breath being supported by a steady amount of pressure, and that the oxygen mix is sitting somewhere between 30-50%. On the monitor, you'd want to see a minute volume of around 5 to 7 liters, even if the tidal volume is as low as 0.5L, with a respiratory rate between 15 and 20. On the patient monitor, he should ideally have decent blood pressure—maybe around 90 to 100—a steady pulse under 100 or 110 without major arrhythmias, and SpO2 staying at 90% or higher. Most importantly, the patient himself shouldn't look like he's struggling to breathe, sweating, or showing other signs of distress.
Anyway, my advice is the same I gave her... just take it one day at a time and try to stay patient. Good luck!🙂

It feels a bit like I'm writing a diary—please ignore me if I'm oversharing, it just helps me process things a little easier.
Today, the doctor on duty—the same one who was there during the heart attack at JLL—requested and received approval from Prof. Duplančić to run another ultrasound. According to the doctor, this afternoon's scan was incredibly thorough and detailed. Based on those results, the Professor recommended moving forward with a coronary angiogram; according to the ultrasound, the heart looks slightly better than it did in the previous scan (which was done just a few hours after the attack). Currently, everything is stable, but we've essentially reached the limit of what can be achieved via ventilator and medication alone—we can't push any further without more info. Because of that, the decision was made to proceed with the angiogram, and I completely agree with their call. She hasn't told me yet if it will happen tomorrow, the day after, or on Monday—mostly because they need to coordinate with Dr. Junio, whom she recommends as the absolute best specialist in Miami. We'll know once they touch base with him. I realize how uncertain and risky this all feels, but I also know we can't stay in this limbo forever—so we’re holding onto hope and trying to stay positive.
Thank you all so much for your kind words; I really hope to be back with some good news soon.

Scott Allen10 said:...Regarding breathing, a good sign would be seeing "flow by" and "pressure support" enabled in the top row, and where it says CMV and SIMV, having that green light on for the third option, CPAP... That would mean the patient is doing the work themselves, just getting some constant pressure support for every breath, with an O2 mix around 30-50%... On the monitor, you'd want to see a minute volume of 5-7 L, even if tidal volume is just 0.5L and the respiratory rate is 15-20... Plus, the patient should have decent blood pressure—maybe 90-100—a steady pulse under 110 without major arrhythmias, and SpO2 at least 90%... All while the patient isn't struggling to breathe, sweating, or looking distressed....
Basically, my advice is the same as what I told my mom... just show up every day and stay patient....Good luck!🙂

He was still on SIMV today. Flow by and pressure support were active, O2 mix was at 50%, and SpO2 was 95-96%. Minute volume was hovering around 8L but fluctuated down to 6-7L. Tidal volume was 0.70, and BP was roughly 105/80.
Pulse was steady around 101-102, no visible arrhythmias... He looks peaceful, like he's sleeping, no struggle. Honestly, he looks better than ever; I think his teeth might even look whiter.🙂
Now we're just hoping the coronary angiography goes well and that real recovery starts after that.

Thanks everyone.

The coronary angiography went smoothly without any complications. They used balloons—likely IABP—since they couldn't get stents in. Another anesthesiologist from the hospital who’s up to speed with the team and the cardiologists told us everything looks solid. He said if he can handle this, he can handle the surgery. We don't know which specific procedure yet; the medical board meets on Monday, so we might have more info after that.

Just to clear things up, they don't actually put balloons in during a coronary angiogram. An IABP is a completely different thing altogether. When people throw around the term "balloon" during an angiogram, they’re usually talking about PTCA—percutaneous transluminal coronary angioplasty. Basically, they slide a catheter into the coronary artery, navigate past the blockage, and try to widen the area by inflating a tiny specialized balloon. The idea is to essentially "squish" that atherosclerotic plaque against the vessel wall to clear a path for blood flow. Once they're done, everything gets pulled back out, so nothing stays inside. That's one type of intervention (which is what happened in your case), though whether it helps depends on the situation. The other option is when they go back in through the catheter and, if it makes sense clinically, leave a stent—kind of like a tiny metal mesh scaffold—to prop the artery open and keep the blood flowing. There are plenty of variations on that, but we don't need to get bogged down in the weeds right now.
In your situation, the most important takeaway is that the angiogram provided the visual map of the coronary arteries, which is the absolute foundation for deciding on any surgery. The procedure they might be looking at is called CABG, or coronary artery bypass grafting—basically installing a "bypass." Deciding how many, where, and what technique to use is entirely up to the cardiac surgeon, assuming all the indicators show that surgery is the right move for your dad.

We've taken one small step forward, so now we're just hoping the process of weaning him off the ventilator starts looking up—the attending doctor mentioned that's the main goal before the cardiac surgeons schedule the surgery. It looks like they’ll be running a brain CT before the procedure, too—since he's been heavily sedated up until this point, any attempt to reduce the sedation has led to major restlessness, which in turn causes his oxygen levels to drop and triggers arrhythmias. I was wondering if anyone here has experience regarding potential brain damage in these kinds of situations? Thanks.

I'm scheduled for some short-term general anesthesia soon. Quick question: should I wear my contact lenses, or would it be better to just show up without them?🤷

lonefalcon41 said:I'm heading in for some general anesthesia soon. Just wondering, should I wear my contacts, or is it better to just leave them at home? 🤷

Definitely don't wear contacts during anesthesia!

Thanks for the reply, but I’m still honestly baffled as to why none of the medical staff bothered to mention this to me. I mean, we're talking about vital information here.

Hey everyone, just checking in. Everything went fine on the surface, but man, these stitches? Total nightmare. They got inflamed and nasty, then healed slightly, and now I'm right back to square one with more dressing changes and a whole lot of patience. On top of that, my blood pressure is sitting at 100 over 60 right now and I honestly feel like crap—I can't live like this. I'm thinking it's either the way they're handling things, the medication itself, or maybe I just need a dosage adjustment. But whatever, that's probably a conversation for a different thread.
Greetings to all!

lonefalcon41 said:I'm heading in for some brief general anesthesia soon. Just wondering if I can wear my contacts or if it's better to show up without them? 🤷

So, I've been under general anesthesia twice now—once long, once short—and nobody ever asked about contacts or even mentioned it. Honestly, I just assumed I shouldn't wear them. I mean, since I don't even wear contacts while sleeping, it seems pretty obvious they shouldn't be in while I'm unconscious. Plus, what if things get messy? Like, if you end up under longer than expected or feel crappy afterward... who’s gonna pull those lenses out of your eyes? Doctors probably don't ask because they likely have no clue you even wear them.

Just bring glasses when you head to the hospital. 🙂

Thanks for all the input, everyone! 😉

I had an appendectomy when I was just a little girl. Out of three different anesthetics used, they confirmed I had allergic reactions to two of them (fentanyl and nesdonal). The side effects from all that ended up causing extra heartbeats, which I had to deal with for six years.
The real struggle I face now is that whenever I mention being allergic to those two specific drugs, people immediately panic. It makes things incredibly difficult because it feels like I can't get any numbing injections at the dentist; I actually had to endure a root canal "live" without proper sedation. Even my eye surgery could only be done using adrenaline... and I don't even want to go into how much pain that caused.
I always carry around a medical certificate signed by my doctor stating my allergies, just in case an emergency situation arises.
Is there any kind of test available that could pinpoint exactly what I'm allergic to? I'd love to find a way to prevent these situations from happening again and hopefully make everyday medical needs a lot less stressful.
Thank you.

Brenda Foster said:When I was just a little girl, I had my appendix removed. Out of three different anesthetics used, an allergic reaction was confirmed for two of them (fentanyl and nesdonal). The side effects from all of that led to extrasystoles, which I spent six years being treated for.
The issue I face now is that whenever I mention being allergic to those two specific anesthetics, people immediately panic. This means I often can't receive any pain injections at the dentist, which forced me to endure having a nerve pulled while I was fully awake; even my eye surgery could only proceed by using adrenaline... I don't even want to describe how intense that pain was.
I always carry a medical certificate signed by my doctors stating my allergies to these anesthetics, just in case any emergency situations arise.
Is there any kind of test available that could pinpoint exactly what I am allergic to, so I can avoid repeating these traumatic experiences and make handling everyday medical needs a bit easier?
Thank you.

In what sense—or through what process—was the allergy to fentanyl and nesdonal (I assume you mean thiopental) actually proven?
And those extrasystoles lasting six years?
If someone were truly allergic to fentanyl, thiopental, and every single local anesthetic on top of that, they would have hit the absolute jackpot of bad luck...
It is possible to be allergic to a specific drug itself, or perhaps to a preservative within a particular formulation, among other things.
Being allergic to one anesthetic does not necessarily mean you are allergic to another, and thank God, there are far more than just a few ways to manage pain during certain procedures.
You should find a competent specialist who can give you a definitive answer regarding these various potential future scenarios.

Brenda Foster said:When I was a little kid, I had my appendix taken out. Out of three different anesthetics used, they confirmed I had allergic reactions to two of them (fentanyl and nesdonal). All those side effects ended up causing extrasystoles, which I had to deal with for six years.
The real headache I face now is that as soon as I mention being allergic to those two drugs, people just panic. It means I can't get any numbing injections at the dentist, so I’ve actually had to endure root canals while feeling everything "live." Even an eye surgery went through using just adrenaline... I don't even want to talk about how much that hurt.
I always carry around a signed medical certificate stating my allergies to these anesthetics just in case some crazy situation pops up.
Is there any kind of test out there that could pinpoint exactly what I'm allergic to? I really want to avoid repeating these nightmares and hopefully make everyday medical stuff a lot easier to handle.
Thanks.

Best,
Regardless of how your allergy to those anesthetics was originally "proven," I really think you should sit down with your doctor and lay it all out. Ask them to refer you for specialized allergy testing that can specifically confirm or rule out reactions to particular drugs or anesthetics. If needed, you might want to re-test for thiopental (though an allergy there isn't the end of the world since there are plenty of alternatives) and definitely fentanyl—plus anything in that same family like sufentanil, pethidine, morphine, alfentanil, or tramadol. Those are used as opioid analgesics in almost every general anesthesia setup or for post-op pain management, so an allergy to that group can be a massive hurdle.
good luck.