need some encouragement

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    this past week I had an 17yo healthy male who had a football scholarship to the local college. I admited him following commands. when we took him down to CT he wouldnt sit still so we gave him .5 Ativan. He was not following when we returned. MD told me to let him know if he doesnt wake up. 1.5 hrs later, clear cut and dry posturing. the rest of the night stat CT, stat MRI, while we were in MRI resident called in the stat OR team to do emergency angio. all I can think is if I hadnt given the Ativan I would have noticed the change 2hrs prior.
  2. 7 Comments so far...

  3. 0
    Quote from dhellwege
    this past week I had an 17yo healthy male who had a football scholarship to the local college. I admited him following commands. when we took him down to CT he wouldnt sit still so we gave him .5 Ativan. He was not following when we returned. MD told me to let him know if he doesnt wake up. 1.5 hrs later, clear cut and dry posturing. the rest of the night stat CT, stat MRI, while we were in MRI resident called in the stat OR team to do emergency angio. all I can think is if I hadnt given the Ativan I would have noticed the change 2hrs prior.

    No!

    No, The Ativan Administration didn't cause either his posturing or prevent you from noticing his worsening condition. You didn't order the Ativan! And .5? That ain't much for a person writhing and having to sit still for a procedure. I'd have given him that and asked for more if they wouldn' sit still....yet we always feel it is somehow our fault.
    Remember they came in Sick!

    Neuro Checks tend to be Q1h...and by the time you reach the door from your exam, they can be off a running downhill!
  4. 0
    Quote from dhellwege
    this past week I had an 17yo healthy male who had a football scholarship to the local college. I admited him following commands. when we took him down to CT he wouldnt sit still so we gave him .5 Ativan. He was not following when we returned. MD told me to let him know if he doesnt wake up. 1.5 hrs later, clear cut and dry posturing. the rest of the night stat CT, stat MRI, while we were in MRI resident called in the stat OR team to do emergency angio. all I can think is if I hadnt given the Ativan I would have noticed the change 2hrs prior.

    Hi, generally, we don't give any sedative for neuro patient because it would masks the neuro deterioration.
  5. 1
    The way I see it, if you hadn't given the Ativan, you would not have been able to get the CT. Then the resident wouldn't have had the info required to need a stat angio. So the way I see it, you sort of saved him. Even if you had noticed the neuro changes without the Ativan, you'd still have to go get a stat CT and sedate him for it...
    litepath2 likes this.
  6. 0
    Quote from MeTheRN
    The way I see it, if you hadn't given the Ativan, you would not have been able to get the CT. Then the resident wouldn't have had the info required to need a stat angio. So the way I see it, you sort of saved him. Even if you had noticed the neuro changes without the Ativan, you'd still have to go get a stat CT and sedate him for it...

    This. Exactly this.
  7. 0
    Quote from ambitious RN
    Hi, generally, we don't give any sedative for neuro patient because it would masks the neuro deterioration.

    DON'T PLACE ME IN YOUR NERUO ICU THEN!!!!!!!

    So how do you control your icp's then if they aren't responsive to mannitol or draining from the a catheter?

    Have worked in a Surgical Trauma Neuro ICU for over 7 years now and would say not once has a nurse missed a neuro change as a result of a sedative. Yes it can happen however I would HIGHLY doubt there would not be other s/sx of change that could not be seen.

    Just sayin....



    To the original poster....you did what you needed to do...would highly doubt 0.5mg masked ANY detoriation especially if the young man started posturing....neuro changes can and will happen....lastly great point about the necessity of the drug to be given in order to get the exam done!!!!!!!!
  8. 0
    You did nothing wrong. I agree with the previous posters, 0.5mg of Ativan is like spitting on the problem. Neuro changes happen in seconds and you did everything you could for this young man. We always take patients like this home in our head, but put yourself at peace.
  9. 0
    Quote from bellehill
    Neuro changes happen in seconds

    When in doubt....Repeat this one Hundred times! When you have a Q1 Neuro check, repeat this one hundred times again!


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