#icus

Just having fun mashing ocs together. This is a really rough sketch of Five Ayam and Remembrance Icus (which them doing this is something that could possibly happen in their canon).

“I recently was in the hospital for a very serious infection that landed me in the ICU. I went to the emergency room and had to wait 28 hours to get a room while being treated. The reason for the delay was there was gridlock in the hospital regarding rooms.

“Many people like me needed hospital care for non COVID procedures and the demand was greater than the supply. Yesterday was the 3rd or 4th day of increased hospitalizations in NC for COVID 19, and it may be trending higher.

“Please stop for a second and remember that we still have the pandemic and you must wear masks, wash your hands and social distance all the time and be vigilant in your everyday life. Your health and life may depend on it. Be safe.”

I'm currently writing a story where my main character is infected with a secret weaponized virus he caught in a lab. It's got a lot of the qualities of meningitis with the added effect that he is hallucinating and terrified (he thinks those who want to help him are out to kill him).

The virus is progressing and they've finally caught him after a long chase, and brought him in for the miracle treatment that will hopefully work (you know that trope). But he's terrified and desperate, even as he gets sicker.

I'm planning to have him in wrist and ankle restraints, but I think it would be cruel to leave him without some pharmacological assistance to calm him down. They can't knock him out completely because they want to monitor the progress of the virus, but is there anything they can safely give him to keep him subdued? Still able to have a conversation, and it's fine if he's a little loopy (it'd be a great spot for a confession between him and another character) but I don't want him any more terrified than he already is. I read your posts on ketamine but I thought the hallucinogenic properties would only make things worse. 

Would midazolam be safe? Or haldol? Or is it unrealistic to sedate him at all? He will eventually lose consciousness on his own as the virus progresses, but I want him to be awake awhile first. 

(Forgot to mention, was considering a spinal tap since it's similar to meningitis with brain swelling, he'd have to be knocked out for that to stay still... how would they do that? Propofol?)

Hey there! Thanks so much for supporting the blog! 

Yes, midazolam would likely be a go-to choice. In fact, if there’s significant violence involved, a “5-and-2″ of 5mg of Haldol and 2mg of Ativan would be a very common dosage (and a favorite of one of one of my favorite hospitals). It’ll actually help the character, since it will keep him from harming himself, staff, and expending too much energy while he’s sick. 

Procedural sedation could theoretically be done with propofol, but someone is going to have to put in an IV. No bueno. (Many ERs don’t use propofol at all, actually; under their logic, this is an anesthesiology-only medication. I find this policy a bit odd and possibly unnecessary assuming quality ER staff, and I carry it on my ambulance, but...) 

In the ICU, the cuffs come off, and propofol is an excellent medication for sedation in this setting (once the IV is in). The reason is that it’s easy-on, easy-off; you can stop the infusion, assess someone neurologically, and put them right back under. Neuro ICUs love propofol. You can’t “shut off” a dose of Versed/midazolam and have it just stop working, it hangs around. Propofol makes it much easier to assess a patient. 

Propofol would definitely get this character deep enough to do a spinal tap :) 

Hope all this helps and thanks again! 

xoxo, Aunt Scripty

wip of the new guy He's an adopt from a buddy (@ivyking214)