We want to recognize Bruce for his diligence in caring for a hemorrhagic stroke patient. This patient was admitted and continued to deteriorate. Because of mental status changes and increased deficits, Bruce contacted Neurosurgery and their APRN. A stat MRI was ordered, but Bruce was told there would be a delay of greater than 1 ½ hours for the test. After multiple phone calls and efforts to get bumped up higher on the priority list, Bruce found that he was able to take the patient to the old MRI. This is not typical or expected of him to do but given the gravity of the patient's declining condition Bruce made this decision.
Bruce stated, "I made a decision to do anything that could possibly be done for this 46-year-old patient. I hope someone would do that for me or anyone else." Because of Bruce making this decision, multiple other procedures were ordered, and the patient was taken to IR for IA verapamil. This potentially could have been a turning point for this patient and it probably saved his life. The patient is currently still with us on the unit but continues to improve gradually.
*****
Bruce recognized that there was a significant change in the patient's condition. The patient was on sedation and intubated which made the assessment even more difficult to detect. Bruce did not know why there was a deficit, but he knew there was a big change in the patient's condition. Bruce immediately notified the doctor for Neurosurgery and APRN. Bruce is well respected for his knowledge and skills so the APN/Resident took his concern very seriously.
They ordered an MRI, CT, and then Angio to reopen the cerebral aneurysm coiling and decrease the vasospasm. MRI told Bruce that it would be 1 ½ hours before they could get to his patient. Bruce was concerned that if he waited for the MRI the patient could continue to get progressively worse, or the condition might not be reversible due to the length of time from the event. He made multiple phone calls until he found a way to get the MRI done immediately. The MRI reported complete occlusion of the coiled anterior communicating aneurysm and vasospasm in the anterior cerebral artery a2 branches, following improved perfusion in both hemispheres including the anterior communicating artery.
Because of Bruce's education and skill, he was able to notice a change in the intubated patient. Bruce's education on possible complications of a cerebral aneurysm helped him to make the decision to get the patient an MRI as soon as possible so that the patient would not lose valuable brain cells. This patient is still weak on the left side but appears to be improving.