Update

Well the troll did well for about ten or twenty minutes but then tried to die on me. 7.18 with a CO2 of 60+ wasn't working out too well. NP CPAP was tried very briefly, but she started to become mottled and had copious secretions so re-intubated she was. It was a valiant effort however, maybe another time.

Trollish

Sooo.... the troll from yesterday is on pressure support now and has GREAT numbers on the monitor, ABG's look good, etc. Except that, that is only when she is asleep! She is a low stim kid to begin with but she really tweeks out when you examine her or touch her in any way. Her end tidal's go up to 70's 80's and her volumes are like 2 per kilo cause she apparently wants to die. We will see what happens but the fellow wants to extubate her in an hour. I'll reserve my judgement untill the kid flys or tries to be celestially discharged. Maybe she will be happy without that tube in her throat and everything will be peachy.

More on that later....

Decent day

It's really good to see one of your patients actually improve, especially in the PICU. So many of these cardiac babies don't make it... I happen to have a hypoplastic left heart though that is actually down to 25% FIO2 and +5 PEEP with minimal support in Pressure Support/Pressure SIMV.
One big kid today too, had a ASD repair and I extubated her without incident after a few hours.
And then there are the trolls. Those kids that shake their sedation off, get pissed and try to die on you. Thank you Baby Jesus for Vecuronium!

First day on the blog

Well not much of anything to say right now! I am at my per diem job at a free standing ER and it is SLOOOOOW. I'm bored and so here I am creating a blog where I will discuss things that I observe and stuff that happens to me at work.
I am a Registered Respiratory Therapist, I work at a large university hospital in the PICU, NICU and Pediatric general care and stepdown floors. I graduated from Mohawk Valley Community College in Utica NY in 2006 so I'm still fairly new at this.

Anyway, thanks for looking if you did and I'm sure I will have plenty of stories to tell in the future.

Oh actually I just thought of one! How about this nurse in the PICU that we will call "nurse death" for purposes of this blog. Not once, not twice, but THREE times she has left a ballard half way down an et tube or trach and then wondered why her PT is desaturating. Hmmm I wonder how that could be?

So the other day I'm walking by a room and nurse death and the fellow are looking at a PT looking rather perplexed. Now this happens to be a infant who is trached and on a vent so I poke my head in to see if I can be of assistance. Nurse Death goes on to tell me, "well I think he needs to be suctioned but he is desatting really bad right now". SPO2 on the monitor is 65%, and I look at the PT. Hmm well here's the problem: the suction catheter is AGAIN about four inches into the tube basically occluding it. I hit the suction button on the vent to give 100% FiO2 and pull the catheter out.

I'm telling her "you can't leave that in there! At all! See the wye right there? That's where the ventilator connects to your patient. If you block it they can't breath! You are lucky he didn't arrest!"

"Oh, I'm sorry I'm sorry" she's babbling.
I just don't see how someone could do this over and over again and be a critical care nurse?

OK, rant is done
Have a great day