Hi Everyone, I am fairly new to ICU so I don't have much experience in the area. It seems to me though, that the patients that I have that are overdoses always seem to come off sedation so volatile.
To make a long story short I weaned a pt from a vent yesterday that had been a stop and drop OD. Positive for Cocaine, Marijuana, and Opiates. Pt was extubated about 15:30. Did great until 5 minutes before shift change and then just went nuts!! End result was pt was held down by 2 local PD and one hospital security and medicated with Ativan and Haldol. (Pt was Marchmant Act and Doc was coming up to sign a Baker act also).
Before I extubated I had only had him on 30 mcgs of diprivan. His MAP was boardering around 65 or else I would have bumped his sedation up because he did wake up twice on that dose quite agitated.
Doc ordered a Precedex drip for extubation which did help, and after the precedex wore off is when he became very agitated, uncooperative, and borderline violent. He ripped off everything and was demanding to leave and attempting to break the bed.
The last pt I had that had a history of cocaine was also extremely violent and threatening towards nursing staff as he came off Propofol also.
Is this a normal reaction for a person that has a substantial history of cocaine or do I just have this kind of luck. Wondering if cocaine changed the brain chemistry that had some kind of influence when sedation is tossed into the mix.
Thanks for any input!