In anticipation of our episode on burnout and wellness, we've got with us Dr. Sarah Gray,

emergency physician and intensivist at St. Michael's Hospital, who's going to be telling us about

one of her worst cases ever on this best case ever series.

Sarah, welcome back to EM cases.

Let's hear one of your worst cases ever.

Okay. Thanks, Anton. Thanks for having me. So here's the story. This was a young man that I looked after in the trauma ICU.

And he had been in the unit for a couple weeks recovering. And he had a really lovely family who was always there at the bedside supporting him. And so he had been involved

in a blunt trauma event and had a variety of significant extremity injuries. But he was also in a halo for an unstable C-spine, and he had

been intubated and on a ventilator for some time. And so the week that I was attending in the ICU,

we decided it was time to change him from an intracial tube to a trache, because we had been

unable to wean him. Whenever we tried

to wean him, he would get extremely agitated and he was a very young, strong guy. And so on that

week, we get him traked and we start trying to wake him up because often once patients no

longer have the tube in, they wake and wean a little bit more easily.

But not this guy. We turned his sedation down that morning, but he woke up wild, so wild that we called a code white.

This is actually extremely uncommon for us in the ICU, but he was agitated enough that he

hit the nurse and he pulled out his IV and we called for security because we were worried he was

going to hurt either himself or other health care workers. And so we wanted to give him a bolus of

propofal, but he had actually pulled that line out.

He still had it at the bedside, but it was just taking a moment to give him the bolus

because the nurse needed to switch the Propheaval to a different line.

And during this time, he was thrashing and he was yelling,

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