ICU Psychosis ?????

Specialties MICU

Published

Just wondering exactly what ICU psychosis is and other's experiences with it.

Yesterday I had a patient that who was extubated after 1 week on a vent & of course, sedated for that week. A few hours after the extubation weird things started going on (would love to, but sorry can't get into the particulars right now because they are so specific...pt still in hospital...other nurses where I work may see it...well... you know...) By the way, is that a full moon I saw driving home yesterday night :coollook: ?

More seasoned nurses on the floor just blew it off as ICU psychosis. But, when I asked exactly how they can be sure it's that and what causes it, they really couldn't explain it.

The patient had IVP Reglan and po hydrocodone about an hour before the 'psychotic episodes' started -any possibility of these inducing the hallucinations and strange thought process the patient exhibited?

I would love to hear your thoughts on this, along with some of the personal experiences with it.

Yes, many of our patients experience "ICU psychosis" / delirium. For the past year or two, we've been using dexmedetomidine gtt to treat it. It works quite well. We slowly titrate the drip to off and we usually have started a PO cocktail to keep the delirium in check.

Of course, there are always patients who don't respond to dex.

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Specializes in Psychiatry, ICU, ER.

I work nights and had a patient with this a couple of days ago, and it was the most frustrating thing. He'd come in with CP and dizziness, lab draws revealed elevated cardiac enzymes. Diagnosed with MI. Admitted him at night on the unit. AOx3. Very pleasant 87 y/o male.

I had him the next night. He still knew what year it was, where he was, and that Obama was president.

But then, an hour in, he started laughing. And picking at his clothes and sheets. He wouldn't admit that anything was wrong and his O2 sats were OK. Then he pulled the sheets down and guffawed, saying he was gonna pull out his foley. I was weirded out, covered him back up and tucked everything back in. Pulled the computer over to watch him. Ten minutes later, bout 2130, I'd left to get printout from the nurses' station. In less than the 2 minutes I was gone, his clothes were off, he's yelling all kinds of weirdness about not having any shoes on, sits up naked on the side of the bed and attempts to perform a flying leap into the wall.

Immediately, images of incident reports and broken hips ran through my mind. I'm sure I wasn't the first person to yell out "OH MY GOD, WHAT THE **** ARE YOU DOING?!?!" in that ICU but I was almost certainly the loudest.

So, of course, restraints went on, docs notified, etc., etc. I called the daughter and she went, "Oh, I'm not surprised. This happened last time he was in ICU. It just happened a lot sooner this time!"

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Specializes in ICU and EMS.

We utilize the CAM-ICU delerium assessment on ALL of our ICU patients. This assessment is performed every 4 hours. If the CAM-ICU assessment is positive, the physicians typically treat with standing Haldol around the clock as well as PRN Haldol.

We have found it to be an extremely accurate tool in standardizing our delerium assessments, and have even caught patients that we didn't realize were +.

Here is a link to the CAM-ICU assessment tool:

http://www.icudelirium.org/docs/CAM_ICU.pdf

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Specializes in MICU/SICU.

Can't Reglan do weird things to some people?

From Wikipedia, so you KNOW it has to be the truth! :lol2:

Common adverse drug reactions (ADRs) associated with metoclopramide therapy include: restlessness, drowsiness, dizziness, lassitude, and/or dystonic reactions. Infrequent ADRs include: headache, extrapyramidal effects such as oculogyric crisis, hypertension, hypotension, hyperprolactinaemia leading to galactorrhoea, diarrhoea, constipation, and/or depression. Rare but serious ADRs associated with metoclopramide therapy include: agranulocytosis, supraventricular tachycardia, hyperaldosteronism, neuroleptic malignant syndrome and/or tardive dyskinesia.[6] Dystonic reactions are usually treated with benztropine or procyclidine.

The risk of extrapyramidal effects is increased in young adults ([5][6] Tardive dyskinesias may be persistent and irreversible in some patients. In 2009, the U.S. Food and Drug Administration required all manufacturers of metoclopramide to issue a black box warning regarding the risk of tardive dyskinesia with chronic or high-dose use of the drug.[10]

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Can't Reglan do weird things to some people?

Yes, Reglan can cause EPS as well as make people extremely anxious and agitated.

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Just give 'em Haldol and throw 'em into Torsades as well while you're at it!

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Specializes in Critical Care.

The Iv Reglan was the culprit I bet. I had a lady acting off the wall, and the docs couldn't quite figure her out. They consulted a Neurologist, and when he saw M.A.R, he said "Thats the problem, Reglan!" He hates that drug, causes lots of mental issues. He dc'd Reglan, and the next day she was much better.

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Specializes in critical care, PACU.

Ive had patients and relatives taking reglan get wierd on me

I work mostly neuro ICU so the story of my life is delirium

screaming, punching, pulling lines, kicking that table connected to the bed, you name it

It makes me wish every patient could be intubated and sedated

Im going to look into that dex drip (it sounds heavenly)

our community has a lot of smokers so I also notice that once we get a patch going the behavior improves

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