Apologies for the lack of post yesterday. That fickle mistress, Sleep, beckoned and I could not resist. The up-side is that you get a double post today!
Schizophrenic patient passing me in the hall today: "This place is a nut house."
Me: "You're not wrong."
Today I learned about a room that I missed during the brief tour on my first day: the isolation room. This is a room with the padded walls that you've seen in movies. Such rooms were incredibly common before new medications were found, starting with the antipsychotic Thorazine in the 1950s. The rooms were used in mental institutions of yore because we had no way of calming down a psychotic patient and, in their fits of confusion, they might hurt themselves. That strategy is considered kind of barbaric now (a whole 60 years later...). But every once in a while the drugs are not enough and we'll have to put a patient in a padded room. Today was one of those days.
I have described a code 66 before. The one other time I've witnessed one of these psychiatric emergencies, the whole process seemed a little overkill. A half-dozen armed police officers along with several people from the other floor joined our entire staff to really just intimidate a non-compliant patient into taking some medication. The patient didn't put up much of a fight and the code ended rather anticlimactically (which is good!).
This time I got to see the real deal. Our patient had become combative with the nurses, kicking one and pushing another. He was unwilling to take any calming medication and threatened to hurt anyone who tried to give it to him. The code was called and the usual battalion of people showed up, ready to get physical if needed. We waited on some special medication to be brought up from the pharmacy and then the whole crew, including police, firemen, nurses, managers, psychologists, and psychiatrists, marched down the hall to the room the patient was holed-up in.
It was an imposing sight. I know so because, along with a nursing student who is learning on the same unit, I was told to stay back because I hadn't gone through the physical restraint training (oh darn...). Instead we watched from down the hall as 15 or so people slowly worked their way into the patient's room, much like clowns into a circus car. From that point on, all we could do was listen. For a while you could tell they were trying to reason with him, though I can't imagine how effective that could have been with that many people standing over him in a tiny room. He yelled angrily and could clearly be heard throughout the hospital floor.
Then something changed. The patient began screaming bloody murder. Not shouting - screaming. I'm sure people outside the building heard him two stories below. Presumably this is when the various care providers determined that talking had run its course and action was needed. Afterwards, I was told about what happened in the room. I'm not sure on the details, but suffice it to say, the patient was poorly restrained, people got hurt, bitten, and spit on - but the patient did eventually get his medication.
Now for my part in the dramatic events! I got to hold the door to the antechamber of the isolation room open as the police et al. dragged the patient down the hall and put him in the padded room. Woot! That's right, 2 years of medical training to be a living door stop. [shrugs] As I told the new nursing student, I'm still just happy when I'm useful at all. She agreed.
We don't just lock away the patient once we have them in the room. They are under constant audio/video surveillance in the nurses station and a staff member must sit outside the door to observe him at all times, in case he tries to hurt himself or he needs medical attention. If the patient can remain calm for an hour, they can be released back on to the unit. It took over six hours for that to happen yesterday, which is rather unusual. The medications weren't as effective on him as for most people for some reason.
The person I felt worst for through this whole debacle was a man who was going to be discharged right before all of this happened. He had already been cleared to go, was wearing his normal clothes, and just needed the final paperwork to be completed. Then he was trapped in the activities room with the other patients for easily another hour or two. As a guy with pretty significant PTSD, he was less than thrilled about being trapped in a uncertain situation in a crowded room with lots of loud noises and yelling going on outside. Thankfully he made it through and got out without any trouble.
ThursdayIL: ICU psychosis is another term for iatrogenic (caused by medical treatment) delirium that arises in acute care units, usually as a result of electrolyte imbalances from IV fluids. As with any delirium, this is a medical emergency.
TIL: The best diagnostic question to ask someone you suspect of having PTSD is "where do you sit in restaurants?" The only two answers you'll get from a PTSD patient are 1) I sit on the back wall so that I can see all the exits or 2) I don't go to restaurants.
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