Panicky hands

Whilst on a placement in ICU, I was carrying out MHI on a patient with sepsis and multi-organ failure. The technique was chosen to facilitate AW clearance and improve lung volumes. In order to recruit atelectatic lung tissue (to increase LV), the bag is held squeezed for a moment after fully squeezing. This mimicks an inspiratory hold, which like SMIs, uses interdependence and collateral ventilation to aid re-expansion. In order to shear secretions, after the squeeze you release your hands to allow the bag to deflate as quickly as possible, which increases expiratory flow. When combined, the sequence is slow squeeze, hold, fast release, but you also have to watch for when the patient attempts to initiate a breath, so you can synchronize with them. If their respiratory rate is too fast, you hyperinflate on every second or third breath. Sounds simple? Being about my third attempt, I was starting to gain confidence that the patient won't die while I'm responsible for breathing for them. I just got into a rhythm, when the patient (who has a history of anxiety) started having an anxiety attack and her respiratory rate skyrocketed. Being someone who usually fakes calmness quite well, I managed to look reassuringly at the patient and with a calm voice encourage her to breath slowly and deeply. On the other hand (no pun intended) my hands reflected my true state of utter panic. I could remember squeeze/release, but timing and technique went out the window. My supervisor advised me to go consistently with every third breath so the patient knows what to expect, which will help calm her. I eventually managed this, and the with continued verbal reassurance, the patient settled. We could then swap her back onto the ventilator.

When stressful situations arise in future I will try to consciously calm my body, not just my mind (this is starting to sound new agey!) In a hands on job makes this an essential skill to ensure patient safety.