PTSD after patient attack

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Specializes in Pediatric Emergency Medicine/Trauma.

On March 8th I was attacked by a teenage psych patient. He'd been in the ER for 12+ hours before I took over his care. He was very large, autistic and in psychosis. He barely responded to our B52 attempts as, despite being 4 pointed, he still tried to hurt himself and anyone who came near. At one point, he was able to get his right hand out of a restraint. I called for help, had about 5 physicians on top of him, and began to re-restrain him. He mustered all his strength and broke out of the hold. He took a hold of me by the neck, flailed and shook me around before I ended up thrown back into the wall.

We had hoped about 48 hours of rest and I'd be ok to return. Unfortunately, it's been nearly 6-7 weeks now. Thanks to nerve injuries at C1 and C6-C8 - I've got issues with my ear (vertigo, nausea, hearing problems) and loss of function and strength in my left arm. My boss chose not to have me back with restrictions at this time (it's an all-or-nothing thought process in the ER).

Now I'm home, doing PT about 3x a week, and still don't have a for-sure prognosis. We're still hoping for full recovery, physically. But the longer I'm off, the higher my daily anxiety has become. I'm worried, scared, frustrated, angry - you name it, I've got it. The first couple weeks, all I wanted was to be back to work. Now, I'm not so sure. I don't want to go back at all at times.

Does anyone have any thoughts, advice, or similar experiences? My PT is hopeful I may be able to return in about another month. I just don't know how to prepare and part of me questions whether I should even go back to that department or look elsewhere. I was really good at what I did - not trying to sound full of myself but I loved my job and excelled. I have wonderful friends and family to support me - but I'm not married, have no children of my own yet, and live alone - - - at the end of the day, it's just me, myself, and I and it's hard to keep self-cheerleading.

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Please, please, please, see if your facility has an employee assistance program, and if they do, use it!

You pegged it in your title. It sounds very much like you are heading in the direction of PTSD from the trauma you experienced. This is not something you should weather alone. Counseling is very much in order, not only for you to make a successful transition back to "the scene of the crime," but to deal with your reactions to the physical challenges you are facing.

I can't say this strongly enough--you need to speak with someone who is skilled at handling PTSD issues. The sooner the better.

I'm so sorry you are going through all of this. Please, take good care of yourself while you're recovering.

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Specializes in Cardiovascular, ER.

Yes, please look into the employee assistance program... that is what they are there for and you should not have to go through this alone.

I'm sorry you have to go through this, I would have PTSD too.... it's what a lot of us are afraid of when working in the ER. Please take care of yourself.

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Please, please, please, see if your facility has an employee assistance program, and if they do, use it!

You pegged it in your title. It sounds very much like you are heading in the direction of PTSD from the trauma you experienced. This is not something you should weather alone. Counseling is very much in order, not only for you to make a successful transition back to "the scene of the crime," but to deal with your reactions to your physical challenges you are facing.

I can't say this strongly enough--you need to speak with someone who is skilled at handling PTSD issues. The sooner the better.

I'm so sorry you are going through all of this. Please, take good care of yourself while you're recovering.

I am not sure what you see in her post that fits with a diagnosis of PTSD? It sounds like a terrifying, even traumatizing experience and she speaks of high anxiety but that doesn't necessarily mean PTSD. It is quite possible that if the OP seeks out support now and gets professional help to work through the situation that she can recover emotionally as well and hopefully not develop PTSD.

I also struggle with calling someone who is autistic and psychotic a criminal and referring to this as a crime. Truly, that is a very stigmatizing attitude. Often when someone is autistic they do not fully understand what is happening and become terrified. Add to that psychosis and possible paranoia or persecutory delusions and you have a petrified teen trying to defend / protect himself from what he may think is people attacking / trying to hurt him. Tying someone in that state down for hours can greatly increase their fear / agitation. Fear and terror gives people superhuman strength.

OP, please do seek out help to recover from this emotionally as well as physically. It sounds like a terrifying experience and having anxiety after something like that is a normal response. Also don't make a decision now about returning or not to the ER. Hopefully a therapist can also work through that piece with you, depending on how your anxiety and feelings are at the time of returning to work. One thing that can help as well is to look at what can be done to prevent this in the future and make you feel safer....are there policies or practices that could be put in place to prevent further similar incidents? Can you get psych support in your ER?

Kudos to your hard work in recovering thus far and hopefully you will have a full recovery. You will get back to excelling as a nurse...in the ER or in another area.

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Specializes in Pediatric Emergency Medicine/Trauma.

I also struggle with calling someone who is autistic and psychotic a criminal and referring to this as a crime. Truly, that is a very stigmatizing attitude. Often when someone is autistic they do not fully understand what is happening and become terrified. Add to that psychosis and possible paranoia or persecutory delusions and you have a petrified teen trying to defend / protect himself from what he may think is people attacking / trying to hurt him. Tying someone in that state down for hours can greatly increase their fear / agitation. Fear and terror gives people superhuman strength.

I agree in that he was in a highly defensive state. I did everything in my power to try to be a calming force in the room. We trialed him without restraints and it was unsuccessful every time - he became extremely violent towards others and himself. Unfortunately we do not have strong policy in regards to violent psych patients - being a pediatric ER it seems "assumed" we don't deal with these situations so getting it the attention it needs is extremely hard. We really did do everything possible before continuing with restraints - got Child Life involved, family involvement, distraction/diversion, environmental changes, etc. I was most concerned about the self-harm he was inflicting on himself.

I don't honestly know if I have "PTSD" but I feel like some of the symptoms are there and I'm more worried they will become worse. My employer does offer Employee Assistance and I think I will call them this afternoon. It's just been very trying of my patience and my frustration levels are very high. I'm starting to feel "judged" by some of my co-workers, and I don't like that. I think many of them feel like I should've returned already - I keep emphasizing I want to be back but it's out of my hands. The doctors and my boss have refused to let me return yet - there's nothing I can do about that. Just another frustration - frankly the morale support has been almost zero. I did everything by the book - I don't know why anyone would think I would "want" this in my life...

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Besides seeking counseling, I would advise you to find other activities to fill your days and to distract yourself. You have too much time on your hands. An exercise program, even if no more than walking the neighborhood, would go a long way toward helping you feel better. Having suffered job related PTSD myself, I empathize and wish the best for you.

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I agree in that he was in a highly defensive state. I did everything in my power to try to be a calming force in the room. We trialed him without restraints and it was unsuccessful every time - he became extremely violent towards others and himself. Unfortunately we do not have strong policy in regards to violent psych patients - being a pediatric ER it seems "assumed" we don't deal with these situations so getting it the attention it needs is extremely hard. We really did do everything possible before continuing with restraints - got Child Life involved, family involvement, distraction/diversion, environmental changes, etc. I was most concerned about the self-harm he was inflicting on himself.

I don't honestly know if I have "PTSD" but I feel like some of the symptoms are there and I'm more worried they will become worse. My employer does offer Employee Assistance and I think I will call them this afternoon. It's just been very trying of my patience and my frustration levels are very high. I'm starting to feel "judged" by some of my co-workers, and I don't like that. I think many of them feel like I should've returned already - I keep emphasizing I want to be back but it's out of my hands. The doctors and my boss have refused to let me return yet - there's nothing I can do about that. Just another frustration - frankly the morale support has been almost zero. I did everything by the book - I don't know why anyone would think I would "want" this in my life...

Sounds like you did absolutely everything you could. I am really sorry your co-workers aren't more understanding. They didn't experience it the way you did and really shouldn't be judging you in any way. You can't go back until you are healthy...and I am glad your boss and doctors are enforcing that. You had some pretty significant injuries that need time to heal. Are there friends / family outside of work you can moral support from? Hopefully your co-workers are actually more empathetic than they are coming across....I don't think any of them would want this in their lives. Maybe they just miss you or are short staffed and want you back, but actually do understand why you need to be off? I'm hoping that is it. Definitely call your EAP...staying on top of your mental health is just as important as your physical health. It sounds like you are on top of this too...recognizing symptoms and seeking help before it gets worse. All the best.

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Specializes in ER/ICU/STICU.

It doesn't sound like enough time has passed for this to be considered PTSD. However that doesn't mean you did not go through a traumatic experience. You definitely should go talk to someone and get some counciling from a professional that can help you work through this. The sooner the better.

As far as going back to work, are you questioning going back because of what happened? Or because of the feelings your coworkers may have about your absence?

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Your co-workers probably do not understand the extent of your injuries. They probably think if it was them, they wouldve shook it off and gone back to work the next day.

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Specializes in School Nurse.

One month is the length of time symptoms need to persist to be considered PTSD.

I would second EAP. They can help alot. I was attacked by a patient also many years ago in a psychiatric unit - he actually just pushed me out of the way and hit the male nurse behind me in the head. That nurse never was able to return to our unit - I am not sure he ever returned to work at all. Bothers me to this day, and this happened nearly 20 years ago. One of the reasons I got out of psych.

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