I’m an ICU nurse, AMA

[Pinkplasticbathcup]

I guess there may have been a few of these a couple of years ago, but in case anyone’s got any more questions

I was in ICU in 2019 - it has affected me a lot, I feel as though there's a gap in my life, a time where other people knew about me & interacted with me but I don't know who they were or what they did to me , iyswim. I have strange memories - I didn't think the consultant was a spy, instead she went around playing the violin. I wished as I was recovering on an ordinary ward I'd asked more questions about it. Is it too late to find out more?

I just want to say thank you.

I've had 2 relatives in ICU in the past 10 years (sadly neither came home :( ) but the one thing I remember was how much the staff cared - not to say the staff on their other wards didn't but as a previous poster said with 9 patients the level of care is different.

I've never forgotten visiting my granddad, and he had a mask on (can't remember the name, not CPAP but similar) and this beeping started. The nurse was on it instantly and explained that it just meant the mask wasn't fully sealed, then asked my granddad if he'd prefer to swap to a regular oxygen mask for our visit so we could talk more easily. She was lovely, I'd never been in ICU before and was a bit freaked out by it all and she was an oasis of calm. Almost 10 years on I still remember that.

I'd better stop rambling and actually ask a question! What if a patient has no visitors, are they left alone for big stretches of time. Just thinking about my uncle who was in during 2021, with my grandma only allowed to visit for an hour a day. I hope, if he was aware, he wasn't too lonely.

My Fil was in ICU and eventually they had to turn life support off after talking to us all. The nursing staff were lovely but far too overworked, there were times we had questions but they didn’t have time to answer and said they would try and come back later but couldn’t always come back. The NHS definitely needs better staffing possibly more than more money.

All nurses are amazing however ICU nurses are angels.

my brother was in ICU for nearly 4 weeks, these amazing nurses didn’t just care and support my brother but cared and supported for my mum and I too. They always had a smile, a hug or a positive word to say even although they were looking after extremely ill people.

staying upbeat and leaving work at work must be so difficult.

Hello
How is it possible that someone could be brain damaged to the point they are not aware of themselves or surroundings but for both brain scans to come back with the results showing minute damage?

Also after a patient is brought round from sedation and wakes up ( eyes open ) but not apparently aware, what makes them go in and out of a natural coma continuously.

If he can feel pain while doing the GCS then surely that makes him have some awareness?

What makes your eyes change colour when at end of life? From dark brown to green then blue?

Do you buy a real Christmas tree or use an artificial one?

Thank you for all you do. I've only been in intensive care once and have very hazy memories of it.
Can I ask you a question please. I'm booked in for surgery in a couple of weeks and have been told that I'll be in intensive care for a few days after the surgery. Is it normal to have a stay in intensive care booked in advance like this?

Disclaimer, i'm an ED nurse ;)

How do you really feel when we rock up in a hurry, the patient is untidy, the leads are tangled and we immediately start begging for our equipment back?

How do you find having patients that are conscious? I was in ICU and completely conscious and aware of what was going on, able to converse, sit up, realistically could have used the toilet if I wasn’t strapped up to so many machines… my nurse said it was strange to have someone who they could converse with

So true, as an icu reg the knowledge divide between ward nurses and icu is phenomenal. It's just a different world really (I always tell the juniors that start with us, if an icu nurse tells you to do something 99% of the time, just do it, which you definitely can't get on a normal ward

My nana passed away in ICU, she had a subrachnoid (sp?) hemmorage (sorry i’ve spelt that totally wrong!). She just one day complained of a pain in her neck, slipped unconscious and then was sedated. They tried to bring her out of sedation but it didn’t work so we had to say bye. When they withdrew the sedation (not sure if thats right?) she passed quickly.
what happens to you when you are sedated? Can you hear? When the priest came to do the last rites she got agitated and started moving even though she was sedated and this brown liquid came out of her mouth. It was almost like she was trying to fight back and say no don’t give up on me. Its often on my mind whether we should have left her sedated longer to see if her body healed but the doctors said she wouldn’t survive so we listened. I don’t know what i’m asking really, I don’t really understand what happened with the sedation. How do you know you can’t bring that person round and they need sedating again? Would she have felt anything when the sedation was withdrawn and they let her pass away?
one thing that stuck with me was how hard the nurses and doctors were working and the skill involved, i’m in awe of you all honestly. Very grateful for our nhs.

It's unfortunately very common, related to the sedation we give and the severity of illness, hallucinations are scary but to be expected. Get in touch with the unit you were on and they'll put you in touch with our clinical psychology who are fab and will see you even if a long while ago

thank you for doing this, fascinating thread!

if someone comes in from an RTA and they have surgery and come back to ICU how is personal care managed? I know it’s probably an odd thing to worry about but if you are perimenopausal with night sweats is that taken care of, or does the patient wake DESPERATE for a shower?

also if it’s not too cheeky to ask a second question, very interested to know about how care & outcomes for severely ill covid patients has evolved over time in your experience?

We do, our long term patients are often petrified of going to the ward and losing their own personal nurse, they need a lot of reassurance that the wards are a good thing and a step in the right direction, but most are v scared to no longer have such low nurse ratios

Also: fully support all nurses and I hope you get pay restoration! Thank you for all your amazing work!

Not necessarily, definitely isn't a hard line of over x we won't admit. We have to be realistic, the older someone is the lower physiological reserve they obviously have to bounce back again. We decide based on existing health problem severity, functional state (how fit they are, how independent they are with washing dressing shopping), how reversible the disease is that they have, so even if relatively frail but something typically reversible such as a pneumonia or low blood pressure from an infection we often "give them a chance". We talk to the individual or their family if they can't talk about their preexisting wishes or beliefs in the instance of health decline, explain what icu involves and that a lot of the things we do to people aren't particularly pleasant and really try to understand their wishes. Many patients say "do everything" others are more on the lines of "keep me comfortable" and it's a consultant decision compromising all of the above. If we think the prognosis is genuinely futile (often people with repeated decline over months) then we won't admit people, goes back to the "do no harm" principle, often our biggest role is intervening and pointing out when enough is enough and that we should be switching to comfort care. It's difficult

@HelloNeighbour2021

I had almost all of this when my dad died of hypoxic brain injury caused by cardiac arrest last April. His mri and ct scan looked almost perfect but he remained semi vegetative for 2 weeks.

My dad had almost the same symptoms as you described except he "didn't respond in a meaningful way to pain" I think his GCS was a 3. He had myoclonic jerks which is never a good sign.

The neurologist could see small amounts of abnormalities on the mri but I was told that how a patient presents clinically is a better indicator for a prognosis than what an mri can show sometimes when it comes to the brain.

So sorry for your loss xx

Theyre definitely not alone much, max nursing ratios is 1:2 patients, there's 3 ward rounds a day where a whole bunch of us drs come round and chat to the patients, physios see them at least once a day, often twice a day, dieticians/psychologists/pharmacists etc all sorts pass through, lots of company :)

I was in icu after I had my baby. You nurses are amazing. Everyone went out of the way to help me and when I was up to it they arranged for my baby to come in and see me. You all do an amazing and I can't praise you all enough xx

Depends on what scans you mean, our most common brain scan is ct which isn't really specific at seeing microscopic changes in the brain, mri is often better but challenging to facilitate in icu as they're long scans, hence a lot is done on clinical examination and brain monitoring of wave forms etc

To wake patients up we just turn off the medicines that are keeping them asleep, as the drugs wear off the patient slowly wakes. A lot of the drugs take a while to clear, particularly jf the kidneys aren't working v well which is often the case so patients can often be a bit sleepy for a while whilst the sedation drifts from the fat and muscle into the blood again where it is eliminated for the body

We don't have total knowledge of what goes in inside the brain in terms of awareness, hence we always chat to our patients in comas as if they're awake. pain responses as part of gcs can be actually primative reflexes rather than a conscious purposeful movement

Definitely, depending on the size of icu at least 30% of our admissions are elective high risk patients, some places like big cancer centres can be 50-55% of our patients :) best of luck, all icu nurses are so so lovely

Have your experiences made you more, or less, frightened of suffering and death?

Really unnecessary & mean. Goodness me, where did she even hint at being better.

Once you back has given out from years of M&H and your knees from checking that wee bag every hour and changing filter bags, what is your plan?
Do you have job in mind that would give you as much joy, passion and adrenaline?

Ex ICU nurse here, miss it terribly!