Ugh

I know that the vast majority of babies are born happy and healthy, (10% if you read the NRP book), but man does working in a PICU expose you to all the other stuff. How would you like to have a 3 day old baby with a constricted aortic arch, an ASD, a VSD (with left to right shunt), webbed neck (think cabbage patch), clubbed foot, and best of all: ambiguous genitalia! Now granted this child will most likely never need to use his gentials for anything except relieving himself but still.
Hey top it off with going septic, holding on to ALL your fluid and ending up on an oscillator while you melt away into the bed.

There is some good news though too here and there. A baby that has spent some time being very sick with a bad hypoplastic left heart has finally left the hospital. She is trached and on a vent. but the parents love her and take very good care of her. It's nice to see someone leave. Another HLHS kid that has coded several times and been on ECMO and failed extubation twice is actually on a nasal cannula and has been extubated for a whole week now.

Yet another hypoplast who had a BT Shunt done is off of ECMO now for two days and as is doing pretty well. As soon as we get his chest closed I belive we may be able to wean and extubate him fairly soon too.

And a teenage girl with a history of lupis who was almost totally paralyzed and had to be trached and vented for months is now able to feel her toes, move her fingers and one arm and can talk again, even without the PMV, and has been off of the vent for 5 days.

Lots of dispair lately

Haven't posted in quite some time, I kinda have been getting sick and tired of the human race. Sometimes I really think the earth would be much better off if we just just hurry up and off ourselves already.

Working in Peds has really opened my eyes to some of the suffering that can go on, as a parent I can't even imagine how I would feel if any of these kids were my own. Had a young teenage girl last week that had horrible NP all inside her left abdomen/chest, went to the OR to try and remove all the dead tissue and they kept calling up reports to the attending like every 20 min. about how much more they were finding. She went to the OR on PRVC because her lungs were starting to get stiff(her CXR was starting to look like ARDS, and we use Pressure SIMV almost exclusively to prevent volutrauma), and I got an oscillator ready for when she came back, just in case.
She ended up coming back after I had gone home, and conventional ventilation wasn't working, her BP was dropping like a stone and she couldn't be oxygentated or ventilated. After a brief stint on HFOV and a long drawn out code she passed away in the middle of the night.

Same room now(it must be haunted), we have another young teenage girl, had osteosarcoma with secondary AML, CMV, fungal balls and influenza. She was in the BMT unit on BiPAP 24/7 for a couple days before she got transferred to the PICU, and you can't live very well on BiPAP continuously. The morning she came over she actually asked to be intubated. Not literally, but she told me and her nurse that "I think I need that tube thing in my throat, I just can't breathe". Pretty sad moment when a kid tells you she needs a vent. Long story short we did electively intubate her vs wait for her to code. Personal opinion though is that she will never come off the vent and will go see baby Jeusus very soon. Apparently the parents were not aware that her condition was life threatening as they were shocked and angered when the MD's told them how dire her condition is.

It's not all bad all the time though, and that's why I can do this job and why I enjoy it. There are a few shining stars that actually get better or at least stable enough to go to stepdown and then transition to the floors and then go home. None of these kids would make it if we did nothing, so a handfull is better than 0 if you ask me.
I actually had a bit of a break and worked the floors yesterday and pushed nebs to my CF kids, saw some asthmatics and only had one rapid response to a baby on a home vent.

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