Trauma question, not sure if this goes here or not...

[Jess-RN in 2006]

If this doesnt belong here, can someone direct me to where it should be, please?

We've got a family situation going on, and as a SN, I'm trying learn as much as I can to help out father-in-law to be.....His wife(boyfriend's stepmom) was in a very bad MVA 8 days ago. She has been in ICU since then,with multiple injuries...it was car vs. Mack truck, and she was hit on the driver's side. She suffered lacerated liver, kidney and spleen, fx pelvis, torn ACL, and her right leg was almost cut off just above the ankle. It has been reattached and is healing nicely. She also suffered a concussion. She has been able to respond to questions, by shaking her head, responds to touch and voice commands, but is not waking up. She is not talking.She is also very jaundiced. She suffered an episode yesterday, with sudden projectile vomiting, of stomach juices, and increased BP and HR. Docs thought she had a stoke, but CT scan came back showing nothing. Her EKG was also normal. They arent sure what happened, they think maybe it was a violent rxn to pain. Now they have decided that she needs to be woke up, and are starting a med tomorrow(FIL not sure what it is) that is to help to wake her up. The docs arent sure why she isnt fully waking up, and I told FIL I would see what I could find out for him.....

My first thought was that her brain is still trying to process all of the trauma she has been through, and will fully "wake up" when it is ready. Is there a specific reason why they would be waking her up? It seems to me, with my very limited knowledge, that it would be better to let her body decide when to fully come around. Am I wrong in my thinking? Does anyone have any thoughts on this case? If more info is needed, I can try and get it for you....

[Morguein]

Is she currently being sedated? Many trauma patients in the ICU are often on pain drips that can make the patient sleepy and sedated. It is good to try and wake the patient up to see how much she can do neurologically, but if she's in a lot of pain, she should be put back on the drip(s)again and gradually weaned off of them as appropriate and within protocol. I'm not really sure what drugs are given to wake a patient up. I've never given medication to wake a patient up...unless they're talking about some sort of antidote for those who are overmedicated(?) If she isn't being sedated, then it is a concern if she isn't waking up fully. Though it is a very good sign that she follows commands and responds to voice and touch. Is she intubated? If so, that would explain why she isn't able to talk. An MRI could also be done incase the CT scan wasn't able to pick up on a small bleed or something else going on in the brain.

[begalli]

Is she currently being sedated?

This was my first thought as well.

When a doc tells me they want to "wake a patient up," it means that we will turn off anything that may be sedating the patient, like Moonepie said.

Frequently in stituations like your boyfriend's stepmom's, the patient WILL be sedated with something like propofol or versed and a narcotic as continuous iv drips. Almost always when they're intubated unless there is already some known neuro deficit.

The reason for waking them up is to check their neurological status because when a patient is on a drug that acts on the CNS, which propofol, versed and narcotics do, it interfers with normal mentation.

A person can also be sedated and responsive, but not completely. And that's why they want to wake them up.

This is quite routine.

[11:11]

Im curious as to what this "wake up" med is and why you didnt post it.

Ive reversed pts before and hate it. Otherwise like previous posters have said often a pt with suspected neuro deficits will be weaned off to establish a baseline, then often resedated. Frequently I'll have neuro pts on propofol to be weaned q Am or q whatever for an in depth neuro check.

Plus if the pts been in ICU for 8 days, sleep deprivation/hyper stimulation otherwise known as ICU-itis could be a factor?

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