A lesson learnt in safety procedures

Hey guys, this week my neurological placement was turning out to be pretty similar to the previous two weeks until Thursday morning. Together with my fellow student and clinical supervisor we were scheduled to see a new patient ‘James’.

James is a 28 y.o. male who was in a car accident approximately 7 years ago. James suffered brain damage mainly to his cerebellum and the fronto-parietal lobe resulting in impairments of motor deficits for the muscles that produce speech, and hemiparesis and spasticity to the right side of his body. James biggest impairment though was the ataxia he has in his trunk which means he spends most of his day (waking hours) in an electric W/C which has bilateral supports at the trunk to keep him in his chair. He is a 2 person max assist for transfers (W/C to SOEB) and is a 1 person max assist for SOEB balance.

The aim of this session was to assess James’ static sitting balance and dynamic sitting balance if appropriate, his bed mobility, and the amount of voluntary movement he has in his limbs. Based upon assessment appropriate treatment techniques and exercises were to be implemented to assist James.

James was T/F to bed via a slide board where we assessed his sitting balance and instigated some sitting exercises which he initially had some difficulty with but improved. This lasted approximately 20 minutes before James was T/F to supine. Through out the whole session James was constantly monitored; he responded that he was feeling good with no problems. Then James bed mobility was assessed and he was asked to move from supine to side lying. After 3 rolls to the right then three to the left I noticed that James was starting to look increasingly tired and fatigued. Each time he came back to supine there was an audible rattle in James’ throat that he tried to clear himself via a tracheal rub.

James movement pattern moving into side lying (esp. left) was quite poor with a lot of neck extension and rotation as opposed to flexion and rotation. James was asked to roll to his left again to try and clear his throat as his rattle was still present. In left side lying James appeared to be losing consciousness. The clinical tutor was very concerned for James’ state and decided to hit the alert buzzer. It started to become clear that James was passing out (probably due to hypoxia) or he was having a seizure (less likely as patient has no Hx of seizures and he was not shaking). The medical emergency team responded very promptly and O2 therapy was required as James O2 saturation had decreased. After about 15-20 minutes James condition started to improve and he returned to an alert state of consciousness.

While this was quite distressing for the patient I found it a fantastic learning experience as the speed with which my supervisor responded was fantastic. She picked up on the signs that were indicating that James may have been drifting out of consciousness very quickly. This reinforced to me the importance of continued monitoring of your patient. Her quick reaction made a big difference to the outcome of the patient.

The other important factor highlighted to me through this event was that neither myself nor my fellow student had been given instructions or the protocol on what to do in an emergency. Considering that this was the third week of our placement it should have been done by now. The message I would like to get across to everyone is to make sure they know the protocols in their department in case of emergency. As initially I was asked to get a mask and suctioning equipment and we had not been shown where they were.

Thanks