Keeping a teenager asleep! How difficult is that?
For a couple of days Joe was stable and we even started to think he might be improving slightly. His sats stayed relatively constant and the nurses had started to decrease the oxygen therapy. He was still heavily sedated and he was also on drugs to paralyse him. I can't remember when they first started to give him the paralysing drugs but I think it was after the 25th. I remember the main sedative drug they gave Joe was propofol; which is the drug Michael Jackson used to help him sleep apparently. It's a strong drug but the half life is quite short so, the theory was, if they wanted to wake Joe up then they could do so quite quickly. This has its drawbacks. However much they gave Joe he seemed to mop it up. I recall one
doctor telling the ICU nurse that they needed to drop the level of
sedation drastically. It appeared that Joe was on enough medication to
'knock out a horse'. I understand that this quite common in young people. They seem to metabolise the sedative drugs rapidly. The nurse was very reluctant to do this as Joe had been coming out of his sedation and on a number of occasions previously he had pulled out his tube and this
caused his sats to take a dip.
I guess I always had realised that it is the nurses who are constantly on the front line, as it were. Being in that ward for a month really solidified that for me. ICU is different from other wards in that the patients are so ill they have one to one nursing constantly. At Jimmy's the nurses do 12 hour shifts so they get to know their patients extremely well, even if they are not in there for long. As it is throughout the NHS though, in the main doctors don't listen to nurses so they reduced his sedation. Not for long...
Joe was wearing a BIS sensor on his forehead to keep a track of his level of consciousness and this was another indicator that we always watched very closely; even more so now he was paralysed. I remember being mesmerised by this indicator almost as much as the oxygen saturation, heart rate and blood pressure. Low numbers from the BIS indicated low brain activity; which is what we wanted at that point. Much as we longed for Joe to come round we knew that a 'controlled coming round' was what was needed and that anything other than that wasn't good. Joe was not a coma patient who needed to wake up, he was a sedated patient who needed monitoring and keeping sedated. I can't imagine anything worse than being paralysed by drugs and then coming round from sedation and be unable to tell anyone that you are conscious. Especially when Joe was intubated and had so many lines in him. So you can imagine that when his sedation was reduced we were apprehensive. Sure enough he mopped up his sedation as if he were metabolising paracetamol. I think it was this day that we came to his bedside and, as was usual, looked straight at the screens. The BIS numbers were over 40 and climbing. I immediately panicked and blurted out 'he's waking up'. The nurse reassured me but gave him a quick 'zap' of more medication - 'just to be sure'. It wasn't long after this that Joe's medication was increased again, back to levels that would 'knock out a horse'.
This was one of the few occasions that made us smile. 'Bloody marvellous' we joked, 'before he came into hospital we couldn't get him out of his pit; now he's here you can't keep him asleep'.
I guess I always had realised that it is the nurses who are constantly on the front line, as it were. Being in that ward for a month really solidified that for me. ICU is different from other wards in that the patients are so ill they have one to one nursing constantly. At Jimmy's the nurses do 12 hour shifts so they get to know their patients extremely well, even if they are not in there for long. As it is throughout the NHS though, in the main doctors don't listen to nurses so they reduced his sedation. Not for long...
Joe was wearing a BIS sensor on his forehead to keep a track of his level of consciousness and this was another indicator that we always watched very closely; even more so now he was paralysed. I remember being mesmerised by this indicator almost as much as the oxygen saturation, heart rate and blood pressure. Low numbers from the BIS indicated low brain activity; which is what we wanted at that point. Much as we longed for Joe to come round we knew that a 'controlled coming round' was what was needed and that anything other than that wasn't good. Joe was not a coma patient who needed to wake up, he was a sedated patient who needed monitoring and keeping sedated. I can't imagine anything worse than being paralysed by drugs and then coming round from sedation and be unable to tell anyone that you are conscious. Especially when Joe was intubated and had so many lines in him. So you can imagine that when his sedation was reduced we were apprehensive. Sure enough he mopped up his sedation as if he were metabolising paracetamol. I think it was this day that we came to his bedside and, as was usual, looked straight at the screens. The BIS numbers were over 40 and climbing. I immediately panicked and blurted out 'he's waking up'. The nurse reassured me but gave him a quick 'zap' of more medication - 'just to be sure'. It wasn't long after this that Joe's medication was increased again, back to levels that would 'knock out a horse'.
This was one of the few occasions that made us smile. 'Bloody marvellous' we joked, 'before he came into hospital we couldn't get him out of his pit; now he's here you can't keep him asleep'.
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