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ICU Awareness PTSD — FRCA Final MCQ

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HardMedicolegal & EthicsICU Awareness PTSDFRCA Final

A 65-year-old man (ASA III) in ICU has a significant unintended awareness event recalled from his period of paralysis and mechanical ventilation. He describes terrifying experiences of being unable to move or communicate while being conscious. He is now developing nightmares, flashbacks, and hyperarousal symptoms. What is the most likely diagnosis?

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Correct answer: C — Depression

Awareness during paralysis and mechanical ventilation is a recognised cause of significant psychological morbidity. This patient's symptoms (nightmares, flashbacks, hyperarousal) occurring after a traumatic ICU awareness event meet the criteria for PTSD. The NAP5 (5th National Audit Project, RCoA) highlighted the ongoing issue of accidental awareness under general anaesthesia/paralysis. Management: early psychological support, formal psychiatric/psychological assessment, trauma-focused CBT or EMDR therapy, and ICU follow-up clinic review. Prevention: adequate depth of anaesthesia monitoring (BIS/entropy), minimise unnecessary paralysis, and consider sedation scoring with validated tools during paralysis.

Reference: NAP5 – 2014 – Accidental awareness during GA; ICS – 2023 – ICU follow-up and psychological outcomes