Janet Chavis, age 73, a retired college professor and Charlotte resident, came to Carolinas Continue CARE Hospital at University from Atrium–Main with primary diagnoses of acute respiratory failure secondary to a heart attack and acute metabolic encephalopathy.

Situation:
Her past medical history included chronic a-fib, HTN, CAD and breast cancer. She presented to urgent care with chest pain, and found to have an acute anterior STEMI followed by V. fib arrest. During 10-15 minutes of downtime, she was given multiple rounds of CPR and defibrillation, and was emergently transferred to the cath lab at Atrium–Main, where she had multiple stents placed due to complete occlusion of her LAD. Post-op, she had hypotension requiring pressor support, which resulted in multiple episodes of V. fib and 45 minutes of CPR. While at Atrium–Main, she was placed on ECMO and experienced multiple complications (fever, HTN, bilateral lower lobe pulmonary abscesses with pleural effusions).

Solution:
Ms. Chavis came to our LTACH for vent weaning, nutritional support, IV antibiotics wound care and rehab. Her goal was to return home. While here, she received physical, occupational and speech therapy, dietary and wound care. Oversight was provided by a nurse practitioner, physician, infectious disease and pulmonology.

Results:
During her 59-day stay at Carolinas Continue CARE Hospital at University, Ms. Chavis was eventually weaned from the ventilator, decannulated and did not require any oxygen upon discharge. She passed a swallow evaluation and tolerated a dysphagia diet with nectar thick liquids. Because of her extended hospital stay with multiple complications and comorbid conditions, she was significantly deconditioned. However, weekly physical, occupational and speech therapy led her to be able to feed herself, self-propel in the wheel chair, advance to standing and take a few steps. Her encephalopathy resolved and she was alert, oriented and participated in her care daily. She was discharged to a subacute rehab facility for continued rehab with the goal to go home.

A significant part of her recovery was due to frequent visits and support from her children and grandchildren.