They don't call it intensive care for nothing

Alex Grant

Faculty: Medical Science
Course: BSc (Hons) Paramedic Science
Category: Allied and public health

5 May 2017

My hospital placement has commenced with the first of five weeks on an intensive care unit (ICU). It has been truly eye opening.

The shifts have been limited to eight hours for each due to the nature of the work, which has been a nice change as opposed to the 12-hour shifts we routinely do on ambulance placement.

My first day entailed a tour of the ward where my mentor showed me the ropes, with all the high-tech equipment and machines. My perception of ICU was very different compared to the reality of the ward; it is a new world to us student paramedics, as we tend not to see the patient past the doors of A&E.

The only time I have previously been in ICU was nearly ten years ago, near home in Sussex for my mum. She suffered a cardiac arrest during surgery and developed complications that led to my brother and I caring for her from the age of ten. Seeing her in intensive care with all the tubes in place still lingers in my mind, but I tried to put that behind me and truly understand the medical perspective. I guess my experience with this has enabled me to connect, on a personal level, to the relatives of the patients I saw this week.

The first shift was uneventful until the final hour, when an emergency admittance came in for a lady with metabolic acidosis. I observed and assisted with the placement of a central line and arterial line, which was incredible to see. The doctors and nurses were nothing below amazing in explaining everything to me, and providing reassurance to the patient. Throughout the week I have also been assisting the nurses with everyday tasks, such as topping up drugs that run through the many lumens in the central line, as well as washing patients and regularly checking the ventilators. Alongside this I have been lucky enough to observe a couple of CT-scan transfers and one surgery.

Towards the end of the week I was placed in a further section of intensive care, away from the main ward. This area is for high-dependency patients that have usually been extubated and are recovering from intense treatment. One patient caught my attention. A young woman was in one of the side rooms, and all I could hear was screaming for the duration of my shift. I was asked to help with patient management and help calm her as much as I could. I found out that this girl had suffered an out-of-hospital cardiac arrest. She had a prolonged downtime (no CPR or oxygenation) but paramedics initiated resuscitation and achieved ROSC (Return of Spontaneous Circulation).

Due to the delay in initial treatment, it has devastatingly left her with a hypoxic brain injury. Hypoxia is the lack of oxygen in the body, which kills the cells and is a reversible cause in cardiac arrest. Depending on which part of the brain is affected it can cause abnormal neurology and behaviour. This particular patient has the Broca’s area affected. This is a region in the frontal lobe of the dominant hemisphere of the hominid brain responsible for speech production. Expressive and motor neurological abnormalities are known as Broca’s Aphasia. The hypoxia has caused this centre to be starved of vital oxygen, which is used in aerobic respiration, and has consequently caused the death of the cells in this area. Essentially, this patient is able to mumble words not grammatically correct, and she cannot understand speech, but there were times where she would say a perfectly correct sentence and times where all she could do were scream.

This poor patient was now in a vegetative state and could not support herself. This is where nursing really plays an important part in caring and compassion. The nurse and I were writing notes at her bedside and out of nowhere the patient burst into tears. It was terrible and upsetting to watch; I had to remove myself from the room. Although we have a great resilience to the horrible things we see in the healthcare profession, there is no harm or shame in admitting when something has affected you.

I guess this patient's condition interested me because of the pre-hospital aspect of her admittance. Out of all of the cardiac arrests I have attended during my time on ambulance placement, the majority have not survived to discharge. It is incredibly rare for a cardiac arrest patient to be able to return to normal life, but we can at least provide the support and appropriate care to family and friends at the time of the incident.

This week has truly been eye opening and I have definitely learnt more about the patient journey. It has shown me not only the technical and clinical aspects of medicine within the walls of a hospital, but emphasised the need for care and compassion for families and patients in difficult and challenging circumstances.

They don’t call it intensive care for nothing.

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