Case Study 5

Female. 18 years-old. Encephalopathy.

An 18-year-old female college student was admitted from an outside hospital. She was found in her dorm room incontinent of urine and febrile up to 104 degrees. She was sent to hospital for further evaluation of presumed autoimmune demyelinating disease. Her admitting diagnosis included:

• Encephalopathy

• Acute Respiratory Failure

• Urinary Tract Infection

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The patient was intubated and mechanically ventilated and was unresponsive. Per Neurology, diagnosis was likely viral encephalitis. She received feedings through a nasogastric tube and started on trach collar trials but had significant anxiety. 

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Special Care Unit

Fifteen days after initial admission, she was transferred to the Special Care Unit. At the time of transfer she had been on trach collar at 40% FiO2. She was able to follow commands but had material cognitive deficits and was unable to swallow anything safely.

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During her stay in SCU, with multidisciplinary treatment from Physical Therapy, Occupational Therapy, Speech and Language Pathology, and Respiratory Therapy, the patient was able to make exceptional functional gains.

She was de-cannulated just 6 days after transfer. Her nasogastric feeding tube was discontinued and she was able to eat a regular diet. Cognition improved and she assisted with booking her flight back home on her laptop computer. She was able to walk a total of 100 feet with seated rest breaks.

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After only 17 days in the SCU, the patient was discharged to an Inpatient Rehab facility in New York for further recovery. She was able to safely travel on a commercial flight. The patient continued to make improvements and was able to return to her university for the fall semester.

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