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31

AUGUST, 2015

Non compliance with psych medications
Road trauma
Emergency admission

Sometimes the only way for people with mental illnesses to get a bed, is to be admitted as a trauma patient. 

The ambulance service received an urgent call.

An elderly man had been seen chasing cars along a major road. The concerned citizen who made the call, suspected he might be a psychiatric patient.

An ambulance rushed to the scene. Too late.

The man had already been hit by a car was lying in the middle of the road. 

The ambulance officers lifted him on to a stretcher and drove him straight to the nearest hospital, sirens screening.

X ray’s revealed a fractured pelvis, fractured left femur and fractured right humerus.

His bones were pinned in theatre and he was sent to recover in Intensive Care Unit.

A central line was inserted to allow cardiac drugs to be given to keep his blood pressure stable. However the line accidentally pierced his  his lung which collapsed.

A catheter was then inserted to pull air out from the pleural spaces. His lungs re inflated slowly. Then man then developed air bubbles under the skin surrounding his chest.

Despite these setback he remained 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 an Intensive Care 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.

She explained that the man had a psychiatric illness but refused to take medications.

It was also impossible to get a community based medication order, to force him to take medical treatment against his will. So he was left to chase cars in a delusional state, and there was nothing his care workers could do. 

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. 

The following day his sister came in and was distressed about this latest disaster. 

“What do we do?” she demanded.

“There is nowhere for him to go, except the streets, and hospitals”.

Wikihospitals 2014

Prevalence of psychiatric disorders in trauma patients: results from a major trauma unit – Critical Care March 2014.