My fellow student and I were treating a man for "chest physio" post MBA and pneumothorax. He spent a week on the ward and during that time, he was extreemly confused and unsure of what time of day it was or how he got there. He started telling stories of incedents that were not related ot his injury. Treatment consisted of ambulation, ACBT, incentive spirometry, and ROM exercises as he was on suction for the ICC.
Within the stay, he started to improve but rapidly declined. The ICC on the left was removed. He contracted a pleural effusion on the right so another ICC had to be inserted. When we arrived on the ward this week, there was a mad rush as the patient began to crash.
He was rushed into surgery with a HR of 170 bpm and on 12L O2 via Non-Rebreathing mask. He is now ventilated in ICU. We went to see him yesterday and he is very ill. We both feel terrible because it was so hard to get him to take deep breaths (plus his sputum was frank heamoptysis!!) and had we tried different stratergies, could it have been prevented? How much of a role do we really play?
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Its interesting Ellen and although I'm not exactly sure what it is that sent him to ICU (you mentioned some head issues - was there an undiagnosed neuro injury that contributed to his crash?) you are very important and the role that physios play in this area is down played.
Having had the prac in ICU we saw several times how poor management led to a patient returning several times to ICU (and unfortunately as a result of PT mismanagement).
The other consideration is that although you can't always do hands on treatment for these patients (as they refuse to take a deep br, won't walk etc etc) often you play a big role in managing the other issues.
Why won;t he take a deep breath? Pain...then good pain management needs to be sorted out. Not using his PCA correctly? then tell someone and discuss switching it to a nurse controlled analgesia if he's non-compus.
We saw a number of times this type of thing happen whilst in ICU and were encouraged to be involved in all aspects of the patients management when it becomes us on the ward looking after these people.
Don't down play the importance of what you do, even though sometimes it seems like simple straightforward, anyone can do it kind of stuff.
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