Code Blue

I'm on my neuro prac and i had my first experience with 'code blue'. I have been treating this patient for the past 2 1/2 weeks and he has improved significantly since then. He's had a (L)paramedian pontine stroke and has a PMH of Parkinson's disease which complicates things a little.

When we first saw this patient he wasn't able to maintain good sitting alignment and we were able to get him to a stage where he's ambulating with moderate assistance of 1 physio and a WZF about 50m. Last week I noticed that after a physio session he seemed to have slumped forward and fallen into quite a deep sleep, I didn't think anything of it. A few days later, we had just finished a PT session about an hour earlier, and I happened to be in his room but treating another patient. His wife asked me to come and look at my pt as he seemed to have dozed off in mid sentence. I went to have a look and noticed that he was 'twitching' in his ULs. He was not responding to anyone's voice. I then went to get a nurse who told me to grab a Dr. By this stage he was convulsing much more and they called the code blue. A similar thing happened yesterday.

After these last few episodes the attitude of the patient has changed markedly. He is more anxious and seems to be more focused on what's going to happen when he's not here anymore. He's a little more hesitant to attend PT because he associates PT with the code blue episodes. We've had a really difficult time trying to convince him to do anything. As it stands we've had to reduce the amount of time of our Rx sessions and the intensity of the Rx. I've found it quite challenging to know how much Rx to give. We've had to balance the amount of Rx: we don't want to give too much but we need to keep him moving forward. The medical staff, however, have been excellent in this situation; encouraging us to do what we can but have cautioned us to be aware of fatigue levels. This experience has reinforced the importance of communication between health professionals and it has also provided me with an opportunity to see the need to balance 2 conflicting needs. Although you don't think about it at the time, but later on it stirs up quite an emotional response. And upon reflection, it was actually quite a difficult situation to witness.