STARES 1- Professional Behaviour

SITUATION
Ms E is a nineteen year old female who was brought in by ambulance to the emergency department of Fremantle Hospital two days ago after overdosing on anti-psychotic medications. Ms E's boyfriend had called the ambulance when he found Ms E sitting on their letterbox coming in and out of consciousness after they had a major argument. Ms E stated to the ambulance workers that she had been drinking alcohol and taken all of the remaining Seroquel (anti-psychotic) tablets in her container (60 x 300mg). On the way to ED the ambulance workers did an elective intubation on assumption she would lose consciousness. On admission to ICU Ms E was intubated with an ETT and sedated on Propofol and Midazolam. She is on BiPAP with a PEEP of 5. When nursing staff tried to wake Ms E, she became very agitated and did not tolerate the ETT, therefore was put back under sedation. On chest x-ray Ms E had decreased lung volumes along with infiltrates throughout the right lung showing that she has begun to go into respiratory failure. She has an extensive psychological history being diagnosed with bipolar disorder earlier this year. She began self-harm in the form of cutting at the age of 14, left school in year 11 and left home when she was 16. She lived with relatives and now lives with her boyfriend and his mother.

TASK
To watch and help when needed in the treatment of Ms E.

ACTION
Firstly we received the hand-over from the morning ICU physiotherapist on what treatment she did this morning and how Ms E tolerated it. We then read her notes and ICU observation chart. We then had to glove and gown up to stop infection spread to the patients. We then watched our supervisor treat Ms E by suctioning and bagging her to help with her sputum clearance.

RESULT
Ms E did not tolerate more than two suctions without dropping her oxygen saturation below 90 therefore her FiO2 had to be increased to 100% during suctioning and bagging. The normal suctioning catheter did not induce a cough in Ms E therefore an angle-tip catheter had to be used which is longer a tipped to an angle at the end to further try to induce a cough. This was successful in obtaining a large amount of M2P2 sputum.

EVALUATION
While I was reading her file I found it hard to grasp that this was the life that this 19 year old girl had gone through, considering I am only 20, it felt a little to close to home. Her psychologists report was over two pages long and I just could not imagine how this girl, let alone anyone has been subjected to the things she has. For someone so young to be lying there on an ICU bed with multiple attachments on her to help keep her alive was very confronting. Watching our supervisor suction this 19 year old girl was pretty confronting, especially when the catheter reached the spot that made her cough. This is because when she was coughing her whole body was shaking and she would go bright red and increase her blood pressure. This wasn't the nicest thing to witness a girl so young be so dependent on people to cough for her and have a machine breathe for her. Afterward I couldn't help but think that ignorance is bliss to this situation. But in saying this I was naive to think that these situations don't happen, because they do and unfortunately to a nineteen year old girl.

STRATEGIES
My supervisor explained to us that it is normal to feel a little confronted by some situations in ICU, as when she first started her rotation in ICU, she too had some cases that really tugged on her emotions. However being exposed to more and more cases that are confronting is the only way that you will 'build up a resistance' and not become so emotionally involved. It is very hard to try to think of strategies to deal with these kind of situations because emotions can sometime be very hard to control. I think I have handled knowing this patient's history and current situation well, I only really thought about the severity and its intensity for that day and night, however if I find myself in another similar situation and find that I am not coping, there is the option to handover the patient to another physio.