I saw him first on my evening rounds.
A tall, strong man around 60, He’d just come back from major bowel surgery

An epidural top-up helped with pain, and put a smile on his face, and his wife’s

They were very pleased at the lack of a colostomy too

Thread...

1/n

Around 2AM, he went wild.

Trying to pull out lines, hit nurses, run away

Screaming we were going to catch him, kill him and he wanted to go home

He was a danger to himself- was on strong medication to keep his blood pressure up, and had lines and drains

2/n

Took 4 people to hold him down so he could have sedation

ICU delirium is unfortunately very common, and we don’t always know what causes it. However, some risk factors are known- sedation, sleep disturbance, noise, being unwell, bright lights at night, etc.

3/n

When I saw him again in the morning, he was calmer... but still looked scared

I sat there, with his wife, explaining exactly what we were doing
Trying to reassure... but could see the barely suppressed panic in those eyes

And then suddenly he screamed
and kept screaming

4/n

We all looked to where he was pointing.

The plasma screen behind the nursing station had flicked to the screensaver...

And suddenly it made sense

5/n

This poor man had been seeing that animation in his confused state, and had come to believe that we were going to catch him & kill him

He recovered well. And we changed the screen saver

We even shared a laugh at a follow up visit

6/n

I suppose what I’m trying to say is:

ICU needs to be a clinical/neutral environment

Can get patients’ familiar objects to help them.

But holiday decorations- especially Halloween- don’t always spread good cheer

They can be deliriogenic to patients

Stay safe.

7/7

@iceman_ex @MarkThomHudson