I was working with a nurse in ICU the other day. We had a very young pt in with pneumonia who was also a drug addict (you name it...this pt used it). Family requested no dilaudid earlier in his stay. Pt was on the vent, hypertensive even with maxed nipride gtt and new start cardene gtt, and an ativan gtt that was currently giving 20mg/hr...pt still extremely agitated, breathing 80 breaths a minute, pulling body up against restraints, trying to bite us, grabbing our scrubs
/stethoscopes, etc. Nurse gave morphine (4mg?) and still agitated. Haldol given...no effect. Respiratory can't find anything wrong with vent. MD finally comes by and says give dilaudid 1-4mg q1-4 hours (which I am not even sure was a legal order at that facility...think you can have only one range in an order). So nurse gives 4mg of dilaudid and pt is out like a light. BUT...as pt is beginning to calm down, one eye deviates to the outer corner...a few seconds later the other eye deviates also to outer corner (pts eyes looked kind of like those of a pug dog) and they remained that way for the rest of the shift. Charge nurse just said to ask the night nurse to put in a neuro consult for in the morning. Family was angry about the pt receiving dilaudid and demanded to know why he wasn't being weaned from the vent...and nothing was said about the eyes obviously.
So my question is...have you ever seen that happen? What would be the term used to describe this pt's eyes? Could it be side effect of med toxicity/OD? Could it be EPS caused by Haldol? One Nurse said she thought the pt might have had a stroke? Would you have told the pt's family? I can't wrap my brain around what could have caused this but it really scared me.