Curious...any of you guys considering Peds/PICU/NICU?

I absolutely love pediatrics. I loved my clinicals in peds and am doing my internship at St. Louis Children's Hospital Emergency Department. I am truly drawn to Emergency Peds.. .I may consider NICU or PICU upon burn out...

Well, here's a brief "day in the life" in NICU....

I get to work and get report on my assignment of 1-3 patients. These can have any number of diagnoses including cardiac anomalies, sepsis, respiratory distress, meconium aspiration syndrome, etc... Let's say I get a 24-weeker, a "feeder-grower" and 1st admit. (we rotate admissions where I work) I set up a "giraffe" bed for admission, a 30k bed that converts from a closed isolette to a radiant warmer in 15 seconds. I assess my 24 weeker, who is around 600 grams in weight, assessing VS, fontanelles, color, tone, lungs, his umbilical or peripheral arterial line, PICC/IV lines, chest tubes, ETT. I make sure his dopamine/dobut gtts, along with hyperal, lipids and fentanyl gtts are running without problems. I check out his High-frequency oscillator ventilator, which is a special vent that pulses 600-800 puffs per minute, "shaking" o2 into his lungs while holding his alveoli open at a controlled pressure. He's already gotten a few doses of surfactant down his ETT to help "ripen" his lungs. His assessment's complete, so I change his diaper and bed linen and reposition him. Doors shut, light off....on to feeder grower... Assess, especially abdomen, checking to be sure he's tolerating his feeds, IV's are intact, especially the 26ga one in his scalp we placed after 4 attempts. Bed linen's changed, NG tube's patency checked, BG fed q3hr formula. Back to bed... ok time to chart... meds due on 24 weeker: Claforan and Vanco, Bumex too... L&D calls for a 35 weeker vaginal delivery. I go with one of our unit's 3 RT's, manage the baby in the delivery room. No resuscitation needed, just a little blowby o2. Back to nicu, more meds and an ABG to get on 24 weeker. Feeder screaming for more food. It's time to feed again. This time I attempt to PO feed with a bottle, slowly teaching the baby how to pace his sucks and breathing. He's slowly getting it...I teach mom and dad how to give him a bath and change him. We also go over discharge paperwork for later this week. ED calls, sick kid, can't get an IV. I go down with another RN. Get the IV in and come back. More VS, ABG's, feeds and meds. My 24 weeker's Hct comes back 24. I start a PRBC transfusion, right before L&D calls again. This time it's a 30 week abruptio placentae. The kid comes out blue, apneic and with a HR in the 40's. the RT intubates as I start compressions and draw up epi. 0.2ml down the ETT...cpr continues. The kid comes around, and we rush him back to nicu to admit him. So now I have 2 vents...another RN picks up my feeder....don't have to worry about that, now. I'm caught in a mad rush. the new kid goes into SVT,,,,I grab the neonatologist and some adenosine, push it. He converts. I hang his and the 24 weeker's IV fluids and chart....more meds due...labs due. Luckily we're a great team and help each other out. Finally it's 7pm. I report off to the oncoming RN before finishing my charting. I've already seen the new kid's family, oriented them to the unit and answered all their questions and gotten consents signed. IV's are in, meds given and labs sent. I'm exhausted, but done for the day.

Some other things I do in NICU:

Ambulance/flight transport
PICC line placement
Codes
Assist with surgery, central line, Chest-tube placement.
I can intubate, place PICCs.

I really enjoy the high-technology and fast pace, including delivery room resuscitations. But I also love taking time to teach and counsel parents, and even just sit for a while and feed a baby,.....It's hard to explain. I hope the above scenario wasn't too scattered, but it's pretty much what happened today at work....


You really can't even compare PICU/NICU with adult ICU. Peds diagnoses are usually not chronic. We get a lot of traumas, including gunshots, ATV accidents, DKA, Asthma, RDS, RSV, etc. You see a lot of the same drugs and treatments, such as vents, chest tubes, central/arterial lines, etc, but not stuff like COPD, Heart disease, ESRD, etc.....


Stephen