Australia - Shey Webber, 35, found badly injured in her Warranwood home
- Thread starter marlywings
- Start date
Almost a month has gone by since Shey was found "face down in the hallway of her Regency Terrace home on November 6."
Quote is from one of the first articles. ^
http://www.heraldsun.com.au/news/la...ind-her-attacker/story-fni0fee2-1226761403547
Quote is from one of the first articles. ^
http://www.heraldsun.com.au/news/la...ind-her-attacker/story-fni0fee2-1226761403547
I can't believe its been a month....
I made up a graphic to be shared on Facebook for any information. It's attached. It's set to the proper social media dimensions so people will hopefully read it.
Download and share it around!
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A month without any real change in her medical status. Pray they are just holding back and that she is in the road to recovery.
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"She's a very strong woman, so if anyone can come out the other side being that beautiful, vibrant girl then she will."
C'mon Shey ... you can do it!
raying:I really hope that at the moment it's a case of "no news is good news" - because I cant stand the silence at the moment.
I can't believe that the police aren't still asking for more information - that Shey has fallen off the radar of the media almost completely.
Hoping this means they are investigating someone specific - that the net is closing in on someone.
A month is long enough to have gone through all internet based contact history. A month is long enough to have applied for warrants for SMS communications. A month is long enough to have back tracked a pre-paid SIM to the point of purchase and examine the Identity details that have to be supplied....
I hope tomorrow the papers run a story for Shey. I hope someone reads it and comes forward with something, however small.
I hope that Shey's professional experience gives her the strength and belief that she can recover from this.
I can't believe that the police aren't still asking for more information - that Shey has fallen off the radar of the media almost completely.
Hoping this means they are investigating someone specific - that the net is closing in on someone.
A month is long enough to have gone through all internet based contact history. A month is long enough to have applied for warrants for SMS communications. A month is long enough to have back tracked a pre-paid SIM to the point of purchase and examine the Identity details that have to be supplied....
I hope tomorrow the papers run a story for Shey. I hope someone reads it and comes forward with something, however small.
I hope that Shey's professional experience gives her the strength and belief that she can recover from this.
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Not a word, not a whisper. I too hope it is no news is good news.
Chris Mack
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Yes, all quite via Facebook.
The moment I get something I will reply, no matter where I am. I am dedicated to this....
I have been sick also, was pretty bad straight in the kidneys I got hit by a viral infection was like getting punched, was really bad.
I will still keep up to the tracking of it via Google. To counter all the terms search Google via "Shey Webber" attack Melbourne, Google searches for the term shey webber via the Boolean expression.
Thanks guys. Luv U all........ Each one of you here is an incredible person.
Regards
The moment I get something I will reply, no matter where I am. I am dedicated to this....
I have been sick also, was pretty bad straight in the kidneys I got hit by a viral infection was like getting punched, was really bad.
I will still keep up to the tracking of it via Google. To counter all the terms search Google via "Shey Webber" attack Melbourne, Google searches for the term shey webber via the Boolean expression.
Thanks guys. Luv U all........ Each one of you here is an incredible person.
Regards
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Hope you feel better soon, Chris Mack! :nurse:
Thanks for keeping us updated on Shey's case... :tyou:
Now that I'm verified and all.... I can give you a little bit of info without getting a timeout 
this is a throwback to multiple posts on page 6.
"Induced comas"
Personally, I hate the term medically induced coma, because it sounds so dire - and you can be kept sedated, intubated and ventilated from something a simple as a dental abscess - because there is the possibility of swelling obstructing the airway.
Any time a person is placed under general anaesthetic they are placed in a medically induced coma. You are intubated, however briefly, and sedated for the duration of the operation.
Its very dramatic wording within the psyche - coma brings images of brain death and loss of all hope.
I recall caring for a patient who had come in for elective day surgery. She had an allergic reaction to the prophylactic antibiotic dose given intraoperatively. Anaphylaxis at home is a serious issue. Anaphylaxis in an operating theatre isn't anywhere near as bad. It's actually the best place to do it. How lucky are you that you first discover a serious allergy in an operating theatre - rather than at home alone when you're sick with a chest infection and you take the first dose of an antibiotic your GP prescribed!!!
You have an anaethesist in the room with you - the well trained gods of advanced life support. They have adrenaline on hand - not because anaphylaxis is common, but because it's also used to treat hypotension due to sedation and/or hypovolemia (blood loss) which are both common in surgery. They have all the drugs. And the reason why anaphylaxis is fatal is because you lose your airway - but guess what ? They had already put one in, right after you drifted off to sleep with a face mask on , counting backwards from 100. The operation will continue. There is no reason why it shouldn't. (Throwing back to an earlier post - this person would have been described as "serious but stable" - the anaphylaxis was a serious and unforeseen occurance, but clinically managed)
Even though the reaction had been handled, we kept her in ICU for the night, and kept the tube in - just in case their was a recurrent reaction.
I have empathy for the fact that this was a scary experience for her - but she really clung to the term "medically induced coma" - and proceeded to text all her family members and friends that statement when we took the tube out less than 24 hours later.
What that meant was that the phone rang off the hook - I'm not kidding - 49 phone calls in three hours. She was the "well-est" patient by a long shot, in all of ICU and HDU - but monopolised resources (ie nursing time) that other patients needed.
An "induced coma" is most often done for what we call "tube tolerance" - it is very difficult for the body to accept volumes, oxygenation, and the rate during mechanical ventilation. There are a variety of different "modes" of ventilation that we tweak based on a patients requirements, in including allowing them to initiate their own breath ( rate ) but providing pressure support or peep to ensure adequate volumes exist in the lungs for gas exchange. The modes are determined by CNS functioning (and this is influenced by level of sedation) as well as respiratory functioning.
Whether through an nasal/endo-tracheal tube (NTT/ETT) or tracheostomy it's unnatural and uncomfortable. Based on the injuries - like rib fractures resulting in a flail segment, chest expansion can be painful for the patient. Someone with multi-organ failure is likely to accumulate fluid in the lungs (APO)- and if they were not intubated, would be breathing rapidly but very shallowly as to not disrupt the fluid bubbling away there - and yet we are forcing expansion - making them cough uncontrollably.
The existence of the tube bypassing the gag reflex is uncomfortable on its own.
We have various levels of sedation, and different sedation drugs available, based on what is wrong with them, and what they need.
The tube has a "cuff" which is inflated to create a seal of the airway, so we can control PEEP and volume. It's a natural reflex to try to pull it out. The trouble is, if the cuff is still up, the pulling out of the tube creates trauma - resulting in bleeding (which enters the lungs) and swelling (which closes off the airway. If a patient manages to pull out their tube - and aggravate their airway, we don't have a lot of recourse available to save them - regardless if how fit and healthy they may be.
Some patients can tolerate a tube while awake. Not many. Mostly those who were expecting it - like a submandibular abscess or epiglottitis. Even then, there is still a risk, that while they are asleep they may try to self extubate - logically they know they shouldn't - but the sleepy brain just wants that thing OUT and doesn't contemplate the consequences.
Typical drugs for sedation used are propofol(the white stuff) either on its own or in a combination of that, fentanyl, midazolam, and precedex (a paralytic). Sometimes we will use ketamine too - because it has a side effect of creating a sort of fugue state - where if traumatic and painful interventions need to take place, the person is not likely to remember it. It's not as common, but very useful for burns patients, who in the early days we scrape down that ravaged flesh on a daily basis to change the dressings and get them on the path towards healing. Burns dressings take hours, and a person on the maximum possible levels of sedation can still wake up during them simply due to the sheer amount of pain we are causing.
We often "wake the patient" by turning off all sedation for as long as it takes to accurately asses neurological functioning. How frequently this is is a risk assessment based on the patient's condition - as the sedation can be aiding in their recovery - it's not all just about the tube! (But the tube always comes first).
There are serious risks caused by prolonged mechanical ventilation - especially VAP (ventilator acquired pneumonia) and so the aim for everyone is to get the tube out as soon as it is possible from a respiratory and central nervous system standpoint.
The drugs we use to sedate people also have an effect on heart rate and blood pressure, which can assist in taking the load off the body - preventing hypertension and tachycardia - which are common during illness and injury so we can protect to a certain extent the heart and kidneys.
Extubation (taking the tube out) can occur only when the person is capable of protecting their own airway. We normally require someone to be able to poke their tongue out and cough on demand (neurological functioning - capacity to obey commands, and ability to protect their own airway) as well as their respiratory capacity to maintain oxygenation.
It's a process that can be fast or slow, that we call wake and wean.
Sedation is gradually decreased, and ventilation parameters scaled down, all the while assessing oxygenation status with arterial blood gasses.
It depends what is wrong with the patient as to how long this takes.
A wake and wean post op - like the lady I mentioned above -is quite simple. She had come in during the afternoon. At midnight, her sedation was turned off. She was groggy but able to obey commands - and tolerated the tube fine The ventilation was switched over so she was basically doing it all herself. A blood gas confirmed it. A laryngoscope showed no residual swelling. Handover on an early shift takes about 15 minutes. I tested her. I got one of our registrars to test her too - he was happy - and viola - she was extubated by 7:35am. And immediately her condition was "good". She went to an ordinary ward not long after.
Some people can take months. Some may never be able to obtain adequate oxygenation on their own (certain traumas like spinal) and will have a ventilator for the rest of their life.
Some people are weaned - are on the mend - and then a sepsis or a VAP makes them deteriorate, and we need to tube them for a second time.
Here is a fast one minute summary of how an emergency intubation goes down. (It's designed as a refresher for rural doctors who know the skill but haven't needed to do it for years.)
[ame="http://www.youtube.com/watch?v=NztDqYlED4M"]JAMIT RSI - YouTube[/ame]
I'll do a little post on trauma and head injuries in general a little later on.
Hope this helps.
this is a throwback to multiple posts on page 6. "Induced comas"
Personally, I hate the term medically induced coma, because it sounds so dire - and you can be kept sedated, intubated and ventilated from something a simple as a dental abscess - because there is the possibility of swelling obstructing the airway.
Any time a person is placed under general anaesthetic they are placed in a medically induced coma. You are intubated, however briefly, and sedated for the duration of the operation.
Its very dramatic wording within the psyche - coma brings images of brain death and loss of all hope.
I recall caring for a patient who had come in for elective day surgery. She had an allergic reaction to the prophylactic antibiotic dose given intraoperatively. Anaphylaxis at home is a serious issue. Anaphylaxis in an operating theatre isn't anywhere near as bad. It's actually the best place to do it. How lucky are you that you first discover a serious allergy in an operating theatre - rather than at home alone when you're sick with a chest infection and you take the first dose of an antibiotic your GP prescribed!!!
You have an anaethesist in the room with you - the well trained gods of advanced life support. They have adrenaline on hand - not because anaphylaxis is common, but because it's also used to treat hypotension due to sedation and/or hypovolemia (blood loss) which are both common in surgery. They have all the drugs. And the reason why anaphylaxis is fatal is because you lose your airway - but guess what ? They had already put one in, right after you drifted off to sleep with a face mask on , counting backwards from 100. The operation will continue. There is no reason why it shouldn't. (Throwing back to an earlier post - this person would have been described as "serious but stable" - the anaphylaxis was a serious and unforeseen occurance, but clinically managed)
Even though the reaction had been handled, we kept her in ICU for the night, and kept the tube in - just in case their was a recurrent reaction.
I have empathy for the fact that this was a scary experience for her - but she really clung to the term "medically induced coma" - and proceeded to text all her family members and friends that statement when we took the tube out less than 24 hours later.
What that meant was that the phone rang off the hook - I'm not kidding - 49 phone calls in three hours. She was the "well-est" patient by a long shot, in all of ICU and HDU - but monopolised resources (ie nursing time) that other patients needed.
An "induced coma" is most often done for what we call "tube tolerance" - it is very difficult for the body to accept volumes, oxygenation, and the rate during mechanical ventilation. There are a variety of different "modes" of ventilation that we tweak based on a patients requirements, in including allowing them to initiate their own breath ( rate ) but providing pressure support or peep to ensure adequate volumes exist in the lungs for gas exchange. The modes are determined by CNS functioning (and this is influenced by level of sedation) as well as respiratory functioning.
Whether through an nasal/endo-tracheal tube (NTT/ETT) or tracheostomy it's unnatural and uncomfortable. Based on the injuries - like rib fractures resulting in a flail segment, chest expansion can be painful for the patient. Someone with multi-organ failure is likely to accumulate fluid in the lungs (APO)- and if they were not intubated, would be breathing rapidly but very shallowly as to not disrupt the fluid bubbling away there - and yet we are forcing expansion - making them cough uncontrollably.
The existence of the tube bypassing the gag reflex is uncomfortable on its own.
We have various levels of sedation, and different sedation drugs available, based on what is wrong with them, and what they need.
The tube has a "cuff" which is inflated to create a seal of the airway, so we can control PEEP and volume. It's a natural reflex to try to pull it out. The trouble is, if the cuff is still up, the pulling out of the tube creates trauma - resulting in bleeding (which enters the lungs) and swelling (which closes off the airway. If a patient manages to pull out their tube - and aggravate their airway, we don't have a lot of recourse available to save them - regardless if how fit and healthy they may be.
Some patients can tolerate a tube while awake. Not many. Mostly those who were expecting it - like a submandibular abscess or epiglottitis. Even then, there is still a risk, that while they are asleep they may try to self extubate - logically they know they shouldn't - but the sleepy brain just wants that thing OUT and doesn't contemplate the consequences.
Typical drugs for sedation used are propofol(the white stuff) either on its own or in a combination of that, fentanyl, midazolam, and precedex (a paralytic). Sometimes we will use ketamine too - because it has a side effect of creating a sort of fugue state - where if traumatic and painful interventions need to take place, the person is not likely to remember it. It's not as common, but very useful for burns patients, who in the early days we scrape down that ravaged flesh on a daily basis to change the dressings and get them on the path towards healing. Burns dressings take hours, and a person on the maximum possible levels of sedation can still wake up during them simply due to the sheer amount of pain we are causing.
We often "wake the patient" by turning off all sedation for as long as it takes to accurately asses neurological functioning. How frequently this is is a risk assessment based on the patient's condition - as the sedation can be aiding in their recovery - it's not all just about the tube! (But the tube always comes first).
There are serious risks caused by prolonged mechanical ventilation - especially VAP (ventilator acquired pneumonia) and so the aim for everyone is to get the tube out as soon as it is possible from a respiratory and central nervous system standpoint.
The drugs we use to sedate people also have an effect on heart rate and blood pressure, which can assist in taking the load off the body - preventing hypertension and tachycardia - which are common during illness and injury so we can protect to a certain extent the heart and kidneys.
Extubation (taking the tube out) can occur only when the person is capable of protecting their own airway. We normally require someone to be able to poke their tongue out and cough on demand (neurological functioning - capacity to obey commands, and ability to protect their own airway) as well as their respiratory capacity to maintain oxygenation.
It's a process that can be fast or slow, that we call wake and wean.
Sedation is gradually decreased, and ventilation parameters scaled down, all the while assessing oxygenation status with arterial blood gasses.
It depends what is wrong with the patient as to how long this takes.
A wake and wean post op - like the lady I mentioned above -is quite simple. She had come in during the afternoon. At midnight, her sedation was turned off. She was groggy but able to obey commands - and tolerated the tube fine The ventilation was switched over so she was basically doing it all herself. A blood gas confirmed it. A laryngoscope showed no residual swelling. Handover on an early shift takes about 15 minutes. I tested her. I got one of our registrars to test her too - he was happy - and viola - she was extubated by 7:35am. And immediately her condition was "good". She went to an ordinary ward not long after.
Some people can take months. Some may never be able to obtain adequate oxygenation on their own (certain traumas like spinal) and will have a ventilator for the rest of their life.
Some people are weaned - are on the mend - and then a sepsis or a VAP makes them deteriorate, and we need to tube them for a second time.
Here is a fast one minute summary of how an emergency intubation goes down. (It's designed as a refresher for rural doctors who know the skill but haven't needed to do it for years.)
[ame="http://www.youtube.com/watch?v=NztDqYlED4M"]JAMIT RSI - YouTube[/ame]
I'll do a little post on trauma and head injuries in general a little later on.
Hope this helps.
icu nurse, it's nice to see you verified! Thank you for all the info!
Feel better soon, Chris Mack. :hug:
Continuing to think positive for Shey, for both her survival and her process of recovery. And for her family, too -- having a family member in this condition is terrible enough, without a violent crime to think about too..
Australia isn't a very 'big' country, population-wise. I think that we, as a nation, could do so much more to discourage and punish violent crime, and have that be (more importantly) very effective in reducing the number of these attacks. In a population our size, that ought to be a manageable task.
This is where my old days of chaining myself to things and chanting slogans raise their heads.. I'd love to have that energy back again, and turn it toward this cause (ok, without the chaining myself to things bit.. probably).
Thank you for all the info!Feel better soon, Chris Mack. :hug:
Continuing to think positive for Shey, for both her survival and her process of recovery. And for her family, too -- having a family member in this condition is terrible enough, without a violent crime to think about too..
Australia isn't a very 'big' country, population-wise. I think that we, as a nation, could do so much more to discourage and punish violent crime, and have that be (more importantly) very effective in reducing the number of these attacks. In a population our size, that ought to be a manageable task.
This is where my old days of chaining myself to things and chanting slogans raise their heads.. I'd love to have that energy back again, and turn it toward this cause (ok, without the chaining myself to things bit.. probably).
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I agree with you Ausgirl . But as long as state governments refuse to build more prisons it is not going to happen. Since they have put a stop to suspended sentences and are not giving early parole the prisons are over flowing. Wonder when they are going to start commissioning the shipping containers.
Ice nurse thanks so much for the info.. still thinking of Shey and wondering at what stage she is at now.
Ice nurse thanks so much for the info.. still thinking of Shey and wondering at what stage she is at now.
Here is a little bit of info about head injuries in ICU.
It's general and not specific to Shey as we don't know the nature or extent.
Head injuries
Brain injuries can occur from a stroke, trauma, a bleed, or hypoxia (not receiving enough oxygen). Care and recovery depends a great deal on the nature of the injury and what treatments were available / delivered.
A person with a brain injury may end up intubated due to the inability to protect their own airway. As my earlier post mentioned, we don't take a tube out without a certain level of neurological functioning, as re intubation is difficult.
Basic neurological assessment:
There is a universal tool known as the Glasgow coma scale (GCS) which all health professionals use for a rapid snapshot of neurological functioning. It is a score out of 15 across three categories - eye opening, best verbal response, and best motor response. It's not perfect by a long shot - because you can have someone who has a severe hypoxic brain injury whose eyes are open spontaneously - but their eyes are not tracking or focussing at all - just lolling about side to side vacantly. Also, it's technically a score out of 12 - because there are no zeros - and even a corpse gets a score of 3. (But you don't necessarily have to be dead to get a three.) a person with a GCS below 8 is likely to be intubated and to remain that way (unless we are doing a withdrawal of care). The full details of the scoring are below. It's one of the areas of my job I dislike the most. To intentionally cause pain to a person every hour.
http://en.m.wikipedia.org/wiki/Glasgow_Coma_Scale
Pupillary response:
A normal individual will have "PEARL" (pupils equal and responsive to light) with a size between 2 and 6mm. A size of 1mm is termed miosis - or pinpoint pupils. These are bad signs, abnormal constriction is usually due to drugs, brainstorm bleeding or toxic chemical exposure. The opposite end of the spectrum - mydriasis - is when the pupils are abnormally dialated - sometimes referred to as being blown.
Unequal pupil size, and pupils that do not respond to light are poor neurological signs - as are pupils that are slow to respond. They are indicative of high intracranial pressure or neurological injury.
Motor strength and movement.
We want to see spontaneous movement with equal strength to all four limbs ideally. In patients with an injury to one side of the brain, hemiparesis (weakness) or hemiplegia (paralysis) across one side of the body is common - such as stroke. There are varying degrees of hemiparesis - and so we score it based on normal, mild weakness and severe weakness.
Challenges in care:
The big concerns are further neurological damage. Bleeding on the brain and swelling needs to be relieved - usually in theatre with a craniotomy and evacuation. We need to maintain cerebral perfusion by having a strict blood pressure range (140-160mmHg) but also ensure that the intracranial pressure (ICP) remains below 20. Some patients may have a drain in their head, set to extract pressure above a specific range. They also may have an ICP "bolt" in their head to accurately monitor their ICP.
Vasospasm - the constriction of blood vessels in the brain , is a concern in certain situations too.
Waking up:
Prognosis and progress are very difficult to assess in the first days and weeks following extubation. The brain can have miraculous capacity to heal itself - but because all the functions of memory, cognition, behaviour and movement, could have been impacted - the state in which someone wakes and spends the first few days / weeks isn't indicative of where they will get to in terms of function.
This can be devastating to families. The patient may not recognise them. They may do strange things, like pull their clothes off and touch their genitals. They may speak in garbled sentences and fully believe they are talking normally. They may get violent. They also may do nothing at all.
It's a long slow road to recovery.
I had the best day of my life (at least as a nurse, but it's impacted me beyond that in terms of hope and faith) on a Sunday early shift two weeks ago. I was allocated a medium term patient that was an out of hospital cardiac arrest. He had been off all sedation for a week but not doing much from a neurological position. The family had agreed to a one-way (palliative) extubation three days earlier. At handover, the plan was to move him to the ward so he could die. His GCS was 7.
I was preparing some of the transfer paperwork when I notices his right leg shift position. While I watched him, he opened his eyes spontaneously. His left hand came up to near his face, and he turned it around and moved his fingers - in the way a baby does (like what is this thing that I have? What does it do?). He didn't respond to me - but this was still optimistic. He closed his eyes and went back to sleep. Two hours later doing my neuro assessment, I asked him to squeeze my hands. He did. He got quite awake , and I got physio in to assess him and work with him. Exhausted after the workout, he was back to being heavily asleep when his family arrived. Downcast. Heartsick. Knowing what today would bring. Tired from being here every day for three weeks.
I explained he had been moving and had been responsive and able to understand and follow commands. They looked dubious, skeptical because he was so still and asleep.
They sat at the bedside, holding his hands. And I say at my desk, wishing hoping and praying.
"What are you doing here [son's name]" shattered the somber silence.
The progress of that morning certainly wasn't over. This was so much more than I was expecting to see. The family burst into tears. Talking. Hugging. I'm not ashamed to say I did too. And I wish I could say I had done something to cause it - as word spread around the ward that I was a miracle worker who transformed a GCS of 7 into one of 14 in just 5 hours.
Nurses came by to say hi to the patient and see it with their own eyes. We all need a little bit of hope - and unfortunately in ICU we don't often get to see people get better to this extent - normally with a brain injury they are transferred when medically stable but mentally still scrambled. A little dash of hope goes a long way.
It's made my week - my month - maybe even my year.
And now I'm hoping that Shey can have the same unexpectedly brilliant progress too.
It's general and not specific to Shey as we don't know the nature or extent.
Head injuries
Brain injuries can occur from a stroke, trauma, a bleed, or hypoxia (not receiving enough oxygen). Care and recovery depends a great deal on the nature of the injury and what treatments were available / delivered.
A person with a brain injury may end up intubated due to the inability to protect their own airway. As my earlier post mentioned, we don't take a tube out without a certain level of neurological functioning, as re intubation is difficult.
Basic neurological assessment:
There is a universal tool known as the Glasgow coma scale (GCS) which all health professionals use for a rapid snapshot of neurological functioning. It is a score out of 15 across three categories - eye opening, best verbal response, and best motor response. It's not perfect by a long shot - because you can have someone who has a severe hypoxic brain injury whose eyes are open spontaneously - but their eyes are not tracking or focussing at all - just lolling about side to side vacantly. Also, it's technically a score out of 12 - because there are no zeros - and even a corpse gets a score of 3. (But you don't necessarily have to be dead to get a three.) a person with a GCS below 8 is likely to be intubated and to remain that way (unless we are doing a withdrawal of care). The full details of the scoring are below. It's one of the areas of my job I dislike the most. To intentionally cause pain to a person every hour.
http://en.m.wikipedia.org/wiki/Glasgow_Coma_Scale
Pupillary response:
A normal individual will have "PEARL" (pupils equal and responsive to light) with a size between 2 and 6mm. A size of 1mm is termed miosis - or pinpoint pupils. These are bad signs, abnormal constriction is usually due to drugs, brainstorm bleeding or toxic chemical exposure. The opposite end of the spectrum - mydriasis - is when the pupils are abnormally dialated - sometimes referred to as being blown.
Unequal pupil size, and pupils that do not respond to light are poor neurological signs - as are pupils that are slow to respond. They are indicative of high intracranial pressure or neurological injury.
Motor strength and movement.
We want to see spontaneous movement with equal strength to all four limbs ideally. In patients with an injury to one side of the brain, hemiparesis (weakness) or hemiplegia (paralysis) across one side of the body is common - such as stroke. There are varying degrees of hemiparesis - and so we score it based on normal, mild weakness and severe weakness.
Challenges in care:
The big concerns are further neurological damage. Bleeding on the brain and swelling needs to be relieved - usually in theatre with a craniotomy and evacuation. We need to maintain cerebral perfusion by having a strict blood pressure range (140-160mmHg) but also ensure that the intracranial pressure (ICP) remains below 20. Some patients may have a drain in their head, set to extract pressure above a specific range. They also may have an ICP "bolt" in their head to accurately monitor their ICP.
Vasospasm - the constriction of blood vessels in the brain , is a concern in certain situations too.
Waking up:
Prognosis and progress are very difficult to assess in the first days and weeks following extubation. The brain can have miraculous capacity to heal itself - but because all the functions of memory, cognition, behaviour and movement, could have been impacted - the state in which someone wakes and spends the first few days / weeks isn't indicative of where they will get to in terms of function.
This can be devastating to families. The patient may not recognise them. They may do strange things, like pull their clothes off and touch their genitals. They may speak in garbled sentences and fully believe they are talking normally. They may get violent. They also may do nothing at all.
It's a long slow road to recovery.
I had the best day of my life (at least as a nurse, but it's impacted me beyond that in terms of hope and faith) on a Sunday early shift two weeks ago. I was allocated a medium term patient that was an out of hospital cardiac arrest. He had been off all sedation for a week but not doing much from a neurological position. The family had agreed to a one-way (palliative) extubation three days earlier. At handover, the plan was to move him to the ward so he could die. His GCS was 7.
I was preparing some of the transfer paperwork when I notices his right leg shift position. While I watched him, he opened his eyes spontaneously. His left hand came up to near his face, and he turned it around and moved his fingers - in the way a baby does (like what is this thing that I have? What does it do?). He didn't respond to me - but this was still optimistic. He closed his eyes and went back to sleep. Two hours later doing my neuro assessment, I asked him to squeeze my hands. He did. He got quite awake , and I got physio in to assess him and work with him. Exhausted after the workout, he was back to being heavily asleep when his family arrived. Downcast. Heartsick. Knowing what today would bring. Tired from being here every day for three weeks.
I explained he had been moving and had been responsive and able to understand and follow commands. They looked dubious, skeptical because he was so still and asleep.
They sat at the bedside, holding his hands. And I say at my desk, wishing hoping and praying.
"What are you doing here [son's name]" shattered the somber silence.
The progress of that morning certainly wasn't over. This was so much more than I was expecting to see. The family burst into tears. Talking. Hugging. I'm not ashamed to say I did too. And I wish I could say I had done something to cause it - as word spread around the ward that I was a miracle worker who transformed a GCS of 7 into one of 14 in just 5 hours.
Nurses came by to say hi to the patient and see it with their own eyes. We all need a little bit of hope - and unfortunately in ICU we don't often get to see people get better to this extent - normally with a brain injury they are transferred when medically stable but mentally still scrambled. A little dash of hope goes a long way.
It's made my week - my month - maybe even my year.
And now I'm hoping that Shey can have the same unexpectedly brilliant progress too.
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Thank you ICU nurse, I'm loving your posts.
I believe dedicated nurses a breed close to angels.
I think we've got one on board here.
I believe dedicated nurses a breed close to angels.
I think we've got one on board here.
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Why the silence?
Two reasons I can think of is Shey has told the police who it was & they're rounding him up or her family has asked for privacy due to the injuries.
Any further news Chris Mack?
Two reasons I can think of is Shey has told the police who it was & they're rounding him up or her family has asked for privacy due to the injuries.
Any further news Chris Mack?
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It's been over a month. ICUnurse that seems a long time for an induced coma? If so her injuries must be horrific & whoever did this must have left her for dead and must be taken off the streets ASAP. OMG Shey was in her own home!!
Poor sweet girl and I feel for her family, they must be exhausted & I pray for good news for them.
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ICUNURSE, have you seen patients waking up from an induced coma and remembering things from ICU?
If found this interesting .....
http://www.telegraph.co.uk/health/6...ma-I-could-hear-people-talking-around-me.html
Unimaginable, isn’t it. Well, actually not to me, for I have been through something very similar. Locked in a coma after an operation went wrong, I heard medical staff discussing my case, without being able to join in. I listened to my wife talking to me, but was unable to respond. And I tried, fruitlessly, to work out how to make contact with her.
If found this interesting .....
http://www.telegraph.co.uk/health/6...ma-I-could-hear-people-talking-around-me.html
Unimaginable, isn’t it. Well, actually not to me, for I have been through something very similar. Locked in a coma after an operation went wrong, I heard medical staff discussing my case, without being able to join in. I listened to my wife talking to me, but was unable to respond. And I tried, fruitlessly, to work out how to make contact with her.
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I remain concerned about the non-responsiveness that Sheys brother & sister in law spoke of in their TV interview.
This article talks about the healing of brain injuries, and how the healing is different for each person.
http://healthpages.org/brain-injury/injured-brain-heal/
As it has been several weeks now, I am truly hoping that Sheys brain swelling has subsided and there are indications of responsiveness.lease:
I am also hoping that police are having some luck in tracking down her brutal attacker.
This article talks about the healing of brain injuries, and how the healing is different for each person.
http://healthpages.org/brain-injury/injured-brain-heal/
As it has been several weeks now, I am truly hoping that Sheys brain swelling has subsided and there are indications of responsiveness.
lease:I am also hoping that police are having some luck in tracking down her brutal attacker.
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