A Crash Course in Trauma Psychiatry

There's a lot to think about with trauma patients even after they're stabilized: their blood pressure, their lungs, the ventilator, multiple drips, pain control, sedation, restraints, wound vacs, infection, sudden hemorrhage, compartment syndrome, kidney failure, and sometimes most difficult of all, their neurological status (are they going to wake up disoriented and combative? or not wake up? and why? drug coma? brain damage?). Trauma patients are different from other patients in the ICU, because they were presumably healthy before their incident (though there's always the chance of drug and alcohol abuse—that might be why you're giving them enough fentanyl to kill a horse), but now anything could fail.

Aside from these physiological problems, however, I find myself worrying about the people themselves. Many of these people are pretty awake while they're going through all this. They may be casted, on a vent, trached, pegged (having a feeding tube), in traction, spinal immobilization, etc, but still awake. It seems like there should be some psychiatric team or something we can utilize to help them cope. Granted, we sedate many of these people with IV drips, but we sedate them for their health, for instance so they breathe better on the ventilator. So if there's no physiological reason to sedate them, they're awake. It's not as horrifying as it sounds (I think!) because they come into this conscious awareness slowly, and they're sick and groggy, but still. Often it's the busy RN who alerts these patients, and their families, to what's ahead: their chances of survival and disability, the rehab plan, how many weeks or months this might entail, what it means for their family or job.

There are more extreme psychiatric problems, too. For instance, one young gang member was shot more than 10 times, through every major internal organ; yet, barring disaster, he'll survive and walk again after rehab. What does this do to his psyche? Does he reform himself? Does he think he's invincible? What about his brothers who come to visit, sobbing, or his multiple young male 'cousins' who might not really be family? It seems like a good time for anti-violence intervention for the visitors and some kind of reformative intervention for the patient.

Or another gang member was shot and got in a wreck trying to drive to our ER. He is paralyzed as a quadriplegic. How do we help him cope? Can we help him cope? Is there even any hope, if he's just going to live out his days in substandard conditions in some public health nursing home?

These personal issues are on the back-back-back burner in everyone's minds in trauma. The nurse is busy keeping the patient alive. The physicians are in and out in five minutes, unless a patient is critical. There are other ancillary staff like dieticians and physical therapists, but these issues are not strictly their concern.

I know this is a pipe dream, that a hospital which is already spending hundreds of thousands in pro bono money to save and recuperate gang-bangers with no insurance, is also going to devote time and money to rehabilitating their souls and trying to make them into good citizens. But I'll at least try to keep this in mind during my nursing career.

The vials of Versed (midazolam), which is often the extent of critical care psychiatry, were photographed by Jmh649.

______
15% off tall scrubs with code "tall_sale"