hallicinations
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several years ago I worked in a neuro intensive care unit. I admitted an elderly gentleman that was exhibiting decreased LOC initially,then great confusion at home. He had been in a small rural hospital without CT so they sent him to us for assessment. He is very confused, pulling out IV, foley etc... so we restrained him. Then he starts yelling for the police, "somebody call nine eleven", "Help,help". I tried everything I could think of to help calm him down, CT earlier had been normal, this guys roommate was a CHI, with ICP monitor that spikes everytime the older guy yells and there is no other bed to put him in. So I call the resident explain the situation and get an order to give 0.5 ativan IV. I give it, and was grateful that it worked. Through the next 4 hours neuro checks show nothing abnormal, he wakes up for me fine. At 0500, he doesn't, can't arouse him at all, I call the resident to get him up to the unit, xray comes in right at that time for portable chest(everyone on our unit got one every morning) and then I get two other nurses in to help me assess and figure out what is happening with this guy, I'm sure by this time I should never have given the ativan. I'm on one side of the bed, another nurse is on the other side and the portable x-ray is hanging over this guy, I try a sternal rub again and suddenly his eyes spring open, he looks at me and screams, I mean screams, looks at the other nurse and howls. It startled us so badly that I took a step back, right onto the overbed table leg, it shoots out from underneath me and I land on my hindend. The other nurse wacks her head on the portable xray as she trys to straighten up away from him. The resident comes running in, the patient is still screaming and howling, the resident is in socks and slips and falls on the floor. The xray tech is laughing so hard she has tears flowing, and another nurse comes into the room holding tongue depressors in the shape of a cross, and the patient truly looks possessed. The roommates alarms are going off, it's a total fiasco! Upshot, we got the elderly man calmed down without medication, because we weren't sure why he wouldn't wake up for awhile in the first place. Took care of the CHI, and then I made a phone call that I hadn't made at midnight because I didn't want to wake family up. After prying information out of this gentlemans daughter-in-law I find out that he had been drinking 2 or 3 manhattens each night to sleep and when that failed, he had added a couple valium to it. Wonder why his LOC was messed up and then he became confused? I had an elderly man who was not a neuro problem, I had someone in DTs, who was hallicinating!
One more from the neuro unit. 19 year old kid with a CHI after a brawl in a bar, MSU student, in the bar on a false ID. After a couple weeks he comes out of his coma, but is still very confused. His mother just can not understand how her son would end up in this postition because he's a good boy that wouldn't do these types of things, must be his friends that got him into it. It has been much harder dealing with her than it has been the patient. One night after hes awake I gave him his neubilizer treatment, and his mother is standing on the other side of the bed. The patient looks at the neubilizer and says "cool, a bong." His mother gasps and says what awful things are your friends showing you? The patient looks at his mother, then at me and says "Isn't she a ***** ? Just hand me the bong!"
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