When his fever spiked, he thought someone was setting him on fire. When orderlies slid him into an MRI, he thought he was being fed into an oven. Frequent catheter changes seemed like sexual abuse. Dialysis? He thought someone was taking blood out of a dead woman’s body and injecting it into his veins.The horrifying, violent hallucinations plagued David Jones, now 39, during a six-week stay in the intensive care unit at Chicago’s Northwestern Memorial Hospital — and for months after he was discharged. He thought he was going crazy and felt very alone.He wasn’t.
AbstractTwo hundred fifty intubated patients were followed during the first 48 h after intubation in order to identify potential risk factors for developing pneumonia within this period. Thirty-two developed pneumonia during this time. Univariate analysis established that large volume aspiration, presence of sedation, intubation caused by respiratory/cardiac arrest or decrease in the level of consciousness, emergency procedure, cardiopulmonary resuscitation (CPR), and Glasgow coma score < 9 were significantly associated with pneumonia. In contrast, prior infection and prior antimicrobial use were associated with a protective effect. Presence of subglottic secretion drainage and 15 other variables had no significant effect. Multivariate analysis selected CPR (odds ratio [OR] = 5.13, 95% confidence intervals [CI] = 2.14, 12.26) and continuous sedation (OR = 4.40, 95% CI = 1.83, 10.59) as significant risk factors for pneumonia, while antibiotic use (OR = 0.29, 95% CI = 0.12, 0.69) showed a protective effect. Our findings emphasize that risk factors for pneumonia change during the intubation period, and preventing pneumonia requires a combined approach
When Lygia Dunsworth was sedated, intubated and strapped down in the intensive care unit at a Fort Worth hospital, she was racked by paranoid hallucinations:Outside her window, she saw helicopters evacuating patients from an impending tornado, leaving her behind. Nurses plotted to toss her into rough lake waters. She hallucinated an escape from the I.C.U. — she ducked into a food freezer, only to find herself surrounded by body parts.Mrs. Dunsworth, who had been gravely ill from abdominal infections and surgeries, eventually recovered physically. But for several years, her stay in intensive care tormented her. She had short-term memory loss and difficulty sleeping. She would not go into the ocean or a lake. She was terrified to fly or even travel alone.Nor would she talk about it. “Either people think you’re crazy or you scare them,” said Mrs. Dunsworth, 54, a registered nurse in the Dallas-Fort Worth area. In fact, she was having symptoms associated with post-traumatic stress disorder
AbstractBackground: Decreased consciousness is a common reason for presentation to the emergency department (ED) and admission to acute hospital beds. In trauma, a Glasgow Coma Scale score (GCS) of 8 or less indicates a need for endotracheal intubation. Some advocate a similar approach for other causes of decreased consciousness, however, the loss of airway reflexes and risk of aspiration cannot be reliably predicted using the GCS alone.Study Objective: A survey of all poisoned patients with a decreased GCS who were admitted to an ED short-stay ward staffed by experienced emergency physicians, to establish the incidence of clinically significant aspiration or other morbidities and endotracheal intubation.Methods: A prospective, observational study was conducted of all patients admitted to the ED short-stay ward with a decreased level of consciousness (GCS < 15).Results: The study included 73 patients with decreased consciousness as a result of drug or alcohol intoxication. The GCS ranged from 3 to 14, and 12 patients had a GCS of 8 or less. No patient with a GCS of 8 or less aspirated or required intubation. There was one patient who required intubation; this patient had a GCS of 12 on admission to the ward.Conclusions: This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED.
I woke up to find myself in ICU. How I got there I still have no memory of to this day. I personally felt fine. Couldn’t understand why I was still in hospital. Nobody told me anything.I was given medication (which I took), because I assumed someone would tell me why I was suddenly on so many new tablets. I can’t remember anyone sitting down & talking to me,about what had happened.My husband told me how I ended up in ICU, but no-one told him anything about the experience of ICU either.What no-one, not even my doctor’s, mentioned was the side effects I was likely to have. Mental as well as emotional side effects that is.For instance no-one told me how WEAK I would be.Did you know you can lose approx. 2% of body muscle per day in ICU.Why? I don’t know, does anyone?ANGER because you feel unable to take your 2nd chance at life.You loose WEIGHT when your in ICU. I lost 2 stone.Did you know your NAILS (hand and toe) stop growing for a while.CONCENTRATION & INTERESTS take a long time to come back. MEMORY LOSS, & HAIR LOSS is another example no-one tells you about.Lack of SLEEP, & APPETITE.You could end up with DEPRESSION &/or PTSD.
During the course of her revival, her towering spirit, encaged in a frail body could not fight and eventually she gave in. It appears that during the surgery, her diaphragm may have got punctured. She developed septicemia, pneumonia, that deteriorated into acute respiratory distress syndrome (ARDS) and brain stroke.How did it happen, especially to a person who was the fittest amongst us all; who was the anchor and strength of our family; who was deeply loved and respected by whoever she came in contact with – we have absolutely no clue, only a few guesses.While she fought for her life, I wrote to the World ARDS Foundation (firstname.lastname@example.org) in sheer desperation, whose president, Eileen Rubin (email@example.com) was a survivor and had been on both sides of the bed to come back and devote the rest of her life, helping other ARDS patients. She explained that the Foundation does not offer legal advice (as it varies from one country’s jurisdiction to another) but they can initiate group prayers for my mom.
This is what they had to say:1. “People need to learn to not judge you because of it. It makes it more difficult for us to keep moving on in the right direction.” — Erin Fox2. “I am still capable of doing lots of things. I have worked really, really hard to overcome my injury and although I now suffer from epilepsy and use a seizure alert dog, I am still the smart, capable, funny uncommonly kind person I’ve always been. Stop telling me I can’t and start helping me reach my next goal.”3. “Remembering things is difficult. I’m not being lazy by only working a few hours a day or needing days off during a busy time — I just need more rest to function than you do… Changes take time for me to adjust to. What works for one person doesn’t always work for me.”4. “I want nothing more than to be ‘better’ and not be judged like I’m a deadbeat for not being what I once was.”5. “The ‘new’ version of myself has very different needs than the old me. I need more rest. I need more time to form thoughts into words. I need more time to complete seemingly simple tasks. And I need my loved ones to realize and be patient with the fact that my emotions are so much harder to manage than they used to be. I still love my partner and my kids, maybe even more than ever, but I also need more solitude than I’ve ever needed before. I need compassion and cooperation. I need love and comfort. I miss the old me so so much… Raising awareness about this issue will be the first thing on my plate, once I can manage to claw my way back to some normalcy… For now, I need my sense of humor more than ever. Because it’s laugh and learn or cry and die, baby. And crying hurts the head.”6. “My injury may be invisible, but my life has been turned upside down. I will never be the same again.” 7. “Never assume a person who has difficulty communicating has nothing to say. They may have plenty to say. They just say things a little differently. Never assume their brain doesn’t work, because it does. It just may work a little differently than ours.”8. “Be patient with us as we learn to be patient with ourselves.” —9. “I need help. To plan a day. A doctors appointment. I need someone to go with me. I need help to shop, cook and clean. I need help to find my limits and rest enough, but I also need gentle support to take small walks and do gentle 2-minute yoga so my body doesn’t stop working altogether. I need friends who come by and say ‘Hi.’ I need hugs. I need to vent and help to look for any sort of silver linings so I don’t go mad. I need new hobbies that are gentle to get my mind off my problems ,and I need help to get started. I need help to help myself.” 10. “My brain takes different paths to understanding and explaining. It’s not a straight road, but one with detours.” —11. “You have no idea how much effort I have to put into all I do. Things I just did automatically prior to TBI require so much work. Everyone goes through moments in their lives which are difficult. For most there is an end in sight, a goal to work towards or for. I have no idea when my difficulties are going to lessen or even if they will. Some days having no ‘finish line’ sucks.”12. “No we’re not the same person we used to be. We’re alive. But we can create a new journey, learn old stuff and new stuff. The strength and determination it takes to learn, try, try, try again, fall down and get back up is painstaking, but worth it.”13. “I live by my systems. I have to have a schedule or I am lost. Don’t freak on me if I get clingy in a new environment. Things that are easy for you are challenging for me. Also, just because I look OK doesn’t mean anything. I have worked for years to get where I am now.”14. “As much as I wish things would go back to normal for her, this is our new normal and I’m OK with that.” —