Medical Miracle

On my cardiopulmonary placement, I was lucky enough to spend my time in an intensive care unit. I was on a rotating roster which meant I spent one week in one part of the ICU and the following week in another part. I first met this patient in my 3rd week of prac, when they were admitted as a multi trauma victim from a 3m fall from a quad bike accident. The patient sustained at least 14 rib fractures, resulting in lung contusions, an occipital skull fracture and multiple lacerations and grazes to the rest of his body.

For the duration of my 3rd week, when initially doing rounds we were not treating this patient for his chest due to the extent of his chest injuries and his chest x-ray was continuing to show that it was essentially clear from any chest pathology. On one occasion the family were present and they enquired as to who we are and why we weren’t treating the patient. My supervisor explained that his chest essentially looked free from infection and that physiotherapy wasn’t indicated due to the extent of his injuries. The family were fine with this and seemed very hopeful and optimistic of recovery for their relative.

After an initial few days in hospital the patient was showing no signs of improvement as they were not breathing spontaneously with the ventilator as the patient was being de-sedated, nil response to verbal command or painful stimuli. Things were not looking good for the patient and the doctors believed that it was time for end of life discussions with the family.

When I returned in my final week, to my surprise the patient was still on the ward, he had a surgical trache inserted, and had developed critical illness polyneuropathy (neuromuscular weakening in critically ill patients) however, the patient was now awake, alert, moving all limbs to command and mouthing words to the hospital staff. I was in complete surprise, and said to my supervisor, “wasn’t this the patient that they were talking about end of life discussions with the family??”

We soon learnt that on the Friday before they had begun rehab sessions with the patient using the pink chair (a rehabilitation chair used in ICU) doing active and active assisted movements of the upper and lower limbs and moving from supine to sitting over the edge of the chair. I then proceeded to work with the patient during that week, running the rehab sessions twice daily. The patient showed huge improvements in strength and the amount of manual assistance required decreased over the duration of the week.

This blog really was to reflect on how amazed I was at the patient’s recovery and the patients own determination to get better. I ended up walking out of each session with him with the biggest smile on my face just knowing how far he had come, and to be honest I was absolutely amazed at the turn around in events. I used the patient’s motivation to my advantage using lots of positive reinforcement, even though by the end of each session he was exhausted, he was still keen to go for an afternoon session.

This was just a happy story, despite all the patients that don’t get better in the ICU, this patient defied all odds and survived. And even though we as physios didn’t have an initial role in the recovery process and chest maintenance, we were able to help in the rehabilitative phase and for this particular patient, proved to be very rewarding for the patient and to me.

The main learning tools I got from this placement were, when to justify when physiotherapy treatment is not indicated, and that every little bit counts with these patients. By this I mean a daily chest check and passive ROM can make the world of difference when the patient is de-sedated and extubated and now progressing into the rehabilitation phase. I was also more importantly able to develop my clinical reasoning skills within a very challenging environment.