This is the fifth in a five-part series examining emergency trauma care at Duke and in the community.
Although Duke Hospital's Intensive Care Unit and Intermediate Care Areas both serve trauma patients, they play separate roles in a patient's recovery process.
The experience of Brent Artrip-a Wake Forest resident and recent patient at the hospital-highlights the distinctions between the two facilities. Driving on Interstate-40 on the night of March 17, Artrip was hit by a van and ejected 60 feet from his truck. Artrip was admitted to the surgical ICU for severe head injuries and other complications, and eventually moved to the Intermediate Care Area.
The ICU is divided into seven general areas of specialization-surgical, cardiac, pediatric, neurosurgic, coronary, medical and neonatal. It is more intensive than the Intermediate Care Area, according to doctors and nurses.
"Our care is more acute," said clinical nurse Michelle May, who works in the surgical ICU.
"You need that nurse to be one-on-one to save a life," she said. Because injuries that necessitate a patient's stay in the ICU are severe, the hospital staff attempts to maintain one nurse per patient, although sometimes they can only provide one per two patients.
They attend to a wide variety of injuries. Recently in the surgical ICU, one patient had a broken neck and several other broken bones, while others had injuries that resulted in bad bleeding, growth of resistant bacteria and a dangerously high level of fluid in the brain.
All patients in the L-Shaped surgical ICU last week were either unconscious or unable to verbally communicate.
Nurses and doctors use complex equipment such as carbon dioxide monitors and breathing machines. Another treatment device, a collar, helps keep one patient's neck in alignment. "When the patient is not able to tell us when he has pain or not, we have to assume the ligaments could be injured," said Hutch Allen, a nurse practitioner.
Having entered the surgical ICU on March 31, Artrip was moved back to the area because of a blood clot in his lungs. He returned to the Intermediate Care Area-also known as the step-down unit-on April 13.
Such moves are unusual. "Rarely, but one or two percent of the time," said Dr. Steven Vaslef, assistant professor of general surgery, "we'll move a patient to the step-down unit and we'll have to move him back to the ICU."
The Intermediate Care Area, which has a triangular set-up comprised of a central monitoring station and 12 beds, uses much of the same types of equipment.
However, Dr. Greg Green, a resident in the trauma unit, said, "It's much less intense, and it's a broader scope. Instead of dealing with smaller issues that might kill a patient in an hour, in 10 minutes, you are dealing with issues that are going to affect how a patient feels in a couple of days and how a patient recovers," he said.
Since a patient's condition is considerably better in the Intermediate Care Area, there are fewer nurses per patient-about three or four.
The higher ratio may be a big change for families that were used to more personalized attention in the ICU.
"You really need your family or close friends to be with you all the time... because the nurses are very busy working with patients," said Artrip's wife Amy. "I think it was a surprise."
Dana Jeffries, a nurse who works in the step-down unit, emphasized the importance of daily activities, including bathing, eating, walking and medication intake. Speech pathologists are also on-hand in the step-down unit-medical staff members who are not found in the ICU.
Milisa Batten, a speech pathologist, said, "a main area that is of main concern to the family is [patients'] speech, language and recognition." Batten and others on staff work with trauma patients such as Artrip, helping them to relearn such simple actions as swallowing.
Artrip, who regained consciousness after three weeks, is also taking small steps to regain "memory, concentration and judgment," according to Amy Artrip.
While Allen is hopeful Artrip will "return to some kind of work," she paused when she said, "If he's fully back to work in six months... I'll be very happy for him."
Small steps in recovery have become important to the Artrip family. During his stay, Artrip saw his 11-month-old son after several weeks. "It was wonderful," he said. "I couldn't ask for a nicer son."
Having lost 25 pounds, Artrip will go to rehabilitation for a few weeks and then have at least a month of outpatient therapy.
"Seeing a trauma patient that comes in [extremely sick] and be on the other end of the scale and walk back through the door," May said, "that's the most rewarding thing."
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