[gradcare]

Hi all,
I am making the move from 10ys plus in adult ICU to a mixed unit which deals with all ICU cases from 4 weeks to well as old as you get. I realise that kids are not just smaller adults and it is a whole new ball game . Anyone got any good advice, pitfalls for new players etc that could help me make the change relativly smoothly? (youngest pt so far was 14 but he was bigger than me [5"9]).

BTW I have kids of my own (2 under 6) does this help or does it make it harder ?

Cheers and thanks

[janfrn]

Hmmm, first thing you should do is refamiliarize yourself with the normal ranges for vital signs. A couple of really important things to remember: kids will stop breathing before they'll lose thier heart rate, and a drop in BP is a VERY LATE sign of shock and it might be the point of no return. A rising heart rate in an otherwise "settled" child is your best first indicator of trouble to come in that respect. Oh, and septic infants might just drop their temps, not become febrile. Practice some med calculations, because every med we give is weight-based... there are no "standard" doses. Be prepared to use a lot more sedation than you might be used to or comfortable with. Trust me, it's necessary. Be prepared for more aggressive treatment for many types of injuries than you'd expect for adults with similar problems. Kids are more resilient than grown-ups and they'll often have better outcomes than you'd think. Welcome to the wonderful world of pediatric critical care.

[gradcare]

Thanks for the input. Wrote to my new NUM (nurse manager) and conned her into sending me the PALS readings which include most of the stuff you mentioned such as "normal" vitals etc. Another plus was the section on airway managment and age groups. Looks like the PDA and notebook will be getting a major workout over the next few months.

[vamedic4]

janfrn your advice as usual is awesome, I'd just add to his other question - it can make it harder if you let it. Anytime there's a code on my unit I'll go home and hug my kids and thank God for every moment I have to spend with them. Working on units where you see repeat families and children can be very rewarding (I work in inpatient cardiology), but when one of your long time patients dies it is very difficult. We just had one of ours pass away about 2 months ago, I'd known her since she was 8 years old - she died at the ripe old age of 20 and left a 2 and a half year old son at home.

I'm just thankful that I get to help these people get better, get out, and get on with their lives.

vamedic4
It's not 0700 yet, is it??

[PedsRN1991]

Have you taken PALS?
I know in the ICU you have to have ACLS, but if you can take a PALS class before you transfer, I would highly recommend it.
Good Luck in PICU!

[janfrn]

Originally Posted by vamedic4

We just had one of ours pass away about 2 months ago, I'd known her since she was 8 years old - she died at the ripe old age of 20 and left a 2 and a half year old son at home.

I'm just thankful that I get to help these people get better, get out, and get on with their lives.

vamedic4
It's not 0700 yet, is it??

That gives me the warm fuzzies, quite frankly. That young lady lived 12 years that she might not have had, and she experienced the joys and pains of motherhood, something she probably never dreamt was possible. Her family had twelve years that were infinitely precious and now they have a small piece of her that will keep her alive for them. And it's because of people like you, people like us.

[gradcare]

Thanks all, I have asked to be run through the hospital based PALS, basic will have to be passed before I go on the floor. I have already asked to do the PALS course when it is next offered.

[gradcare]

Addition to last post.
Vamedic4 KI held my eldest while they did NP aspirates and blood cultures while they medicos were telling me he probably had meningococcal sepsis when he was 2 and could cope (fortunatly they were being cautious and he didn't have it) is this a fair indication?. I guess with it being a mixed unit (age 4 weeks to 80 years) I'll be able to rotate out for a while if it gets too much.

Thanks again for the advice

[vamedic4]

Originally Posted by janfrn

That gives me the warm fuzzies, quite frankly. That young lady lived 12 years that she might not have had, and she experienced the joys and pains of motherhood, something she probably never dreamt was possible. Her family had twelve years that were infinitely precious and now they have a small piece of her that will keep her alive for them. And it's because of people like you, people like us.

Thank you janfrn....I truly enjoy working in peds. It's by far the most rewarding thing I've ever done...not even being a medic in the field compares to the work I do here.

vamedic4
today's the long sleep day!!

[janfrn]

I have always had a special love for peds and PICU in particular. Although yesterday, yet another Gold Star day, my love was sorely tried!! We started the shift short-staffed; I had what on the surface looked like a safe doubled assignment, but turned out not to be. Then, while I was on my first coffee break, at 1115, the cath lab staff rolled a child in PEA through the doors... at the same time that our CV-OR patient was arriving. I had to hand over my stable patient to another nurse because they had to move her into a different part of the unit so the coding kid could go into her bed space. The unit manager, the intensivist, both our residents and the fellow were all in with a little RSVer who was failing on HFOV and was going to be electively cannulated for ECLS. What a schmoz! The manager of patient care, the director of the ECLS program, both CV surgeons and a host of other people came out of the woodwork to cannulate the kid from the cath lab. Everyone was pressed into service to get the job done. After the dust cleared, the manager came around and handed out gold star pins to the staff involved. I had to quite vigorously remind her to reward our two nursing assistants and the unit clerk as well, because they never seem to get credit for all the hard work they do.

Why the gold star? It started out as a joke; we had a temporary manager who would give us little sticky foil stars whenever we did something she felt praiseworthy. Then later on we were surveyed by a PhD candidate about the culture in our unit and what obstacles it presented for providing excellent care. The responses where pretty surprising to our management who didn't realize that we needed some sort of meaningful recognition for a job well done. So they took Gwen's sticky star thing and turned it into a gold star pin and began handing them out when things have been particularly challenging in the unit, starting about six months ago. I work part time and already have three to them. They're starting to lose a little of their luster, because our staffing patterns and the number of very junior nurses we have guarantee that most shifts will be challenging. If yesterday would have been a Monday instead of a Wednesday, 3/4 of the staff would have been nurses with less than a year of PICU experience, many with less than a year of any nursing experience. It's scary!

But I still haven't moved on, so it must be something I'm willing to cope with for now!