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31

AUGUST, 2015

Non compliance with psych medications
Road trauma
Emergency admission

What are homeless, psychiatric patients doing in Intensive Care beds?

The ambulance service received an urgent call. A man had been seen chasing cars along a major road. The person who called, suspected he might be a psychiatric patient. The ambulance rushed to the scene. The man had already been hit by a car, then left lying in the middle of the road. The car had driven off.

The ambulance officers struggled to stabilise the man, who was unconscious and covered in blood. The ambulance drove him to the nearest hospital, sirens screening.

The man was diagnosed with fractured pelvis, fractured left thigh bone and right forearm. His bones were pinned in theatre and he was sent to recover in an Intensive Care Unit. A large intravenous line was inserted to allow cardiac drugs to be given to keep his blood pressure stable. However the line accidentally pierced his lining of skin around his lung. His lung collapsed.

A catheter was then inserted to pull air out for the spaces between the layers of the lung. His lungs re inflated slowly. He then developed air bubbles under the skin surrounding his chest. Despite this setback he was stable. After 24 hours the man was slowly weaned off sedation, so he could do deep breathing and coughing.

Intensive care

He awoke to find himself lying in a hospital bed, surrounded by beeping machines, strapped up in a pelvic support brace, a plaster cast on his arm and his leg in a brace.

“I want to go to the pub” he announced to his nurse. “You are sick” she replied, “you’re in intensive care to recover from a road accident”.

“I want to go to the pub, now” he repeated. He began to try and climb out of the bed. Despite entreaties from nurses and doctors he refused to settle down. Eventually his sedation was increased.

The following day his care worker came in to the Intensive Care Unit. The care worker explained that the man had a psychiatric illness but refused to take medications. It was impossible to get a community based medication order, to force him to take treatment against his will. So he was continuously self destructive and there was nothing his care workers could do. One of his regular behaviours was to chase cars along the main road.

He had been involved previous traffic accidents. No matter how many times his care workers approached the government, there was no long term accommodation available for psychiatric patients. His care workers simply had to keep an eye on him, and call the ambulance when he wandered back onto the roads.

The following day his sister came in and expressed concern about his long term future. “What do we do?” she asked. “There is nowhere for him to go, except the streets, and hospitals”.

Wikihospitals 2014

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