The LEAST critically ill kid you've cared for in PICU :)

  1. 6
    So last night I admitted an eleven-month old fro the ED into a PICU bed for acute asthma. The floor doc declined him due to his 'instability' and 'acute distress'.

    The first HOUR this kid spent in the PICU was spent jumping up and down in the crib- without a break, all the while laughing and carrying on. He then collapsed in exhaustion from all the bouncy-house action in the cage crib, and slept peacefully- satting 100% on room air with clear breath sounds - the entire rest of the shift. Until I woke him up for Orapred- which (mixed with a little pancake syrup) he chugged down like a cold beer on a hot day.

    So- I am proposing a light-hearted thread devoted to those 'Why is this kid in the PICU?' moments we all have.

    Ready...set...GO!
    HazelLPN, fiveofpeep, Esme12, and 3 others like this.
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  4. 26 Comments so far...

  5. 2
    Sigh. Every one of our post bt-shunt/norwood sano babies who cry on the step down and turn blue. Get rapid response on the floor, sent to us, pop a paci in the kids mouth, swaddle and off to sleep with sats in the low 80's (normal for these kids). What irks us is that these kids CAN'T be left to scream for hours on end (yes, they will eventually code if they do) but they are ignored until they can't be consoled and then they bounce back to us, which totally stresses the parents out. We don't have an in between unit and sometimes these kids bounce back and forth multiple times within a week or two!

    Had another one recently, post decannulation of his trach. They are always monitored for 48 hours post decan. This one is just about two and if someone wasn't literally running​ him around the unit in his stroller he was having a complete melt down. Luckily his parents were there most of the time to do the running!
    uRNmyway and Esme12 like this.
  6. 10
    Been there, done that with the asthmatics that wind up in the PICU on room air and q4 albuterol. Usually they are transfers from outlying hospitals that rarely see peds and completely misrepresent the presentation during report.

    Then there's the known diabetics in "DKA" with sugars in the 200's and a pH of 7.3 whom we transition back to their subcutaneous insulin regimen practically on admission.

    The older infants/toddlers that have simple general surgery procedures (think colostomy closure) and come to the PICU just because they are ex preemies.

    Then there's the kids who get admitted for political reasons. I kid you not, we had a doctor try to tell us, "Well, if the parents don't want to spend the night in the hospital I'll admit the kid to the PICU so she can have a nurse with her all night." ..... We had to tell him, sorry, buddy, but it doesn't work like that. We're an ICU, not babysitters.
    WoosahRN, canoehead, besaangel, and 7 others like this.
  7. 0
    Not a PICU nurse but used to float to PICU at my hospital and we admit kids to PICU daily that don't need a PICU bed. It is a waste of resources but unfortunately our PICU is seldom full and our peds floor always is so floor kids always go to PICU. Because of the lack of floor beds these kids seldom get moved to the floor but are instead d/c'ed home from PICU
  8. 0
    This is the day-to-day woe of most nurses in my PICU more often than not.

    We are often described as more of an HDU than an ICU, simply because we typically have more stable patients that unstable or intubated patients.

    I could go on for hours about the 'most stable' patient I've looked after...

    Ex-prems now chronic trache-vent dependent stuck in PICU until the previous kid on the ward gets home because the ward only accepts 1 trache kid at a time (and they can't go home quickly because of lack of government funding for ventilated kids). I spent Christmas day opening presents and dressing a seven month trache-vent dependent bub (who was medically fine -- long term vent) because he hadn't made it to the ward yet. He went to the beach in the afternoon and I had NO patient!

    We've a few kids with neuro issues get trached recently. Came in for handover after a few days off to hear one of them had gone to the beach and had ice cream with mum and dad and the other went up the road for coffee and cake with parents. (Getting kids with traches onto the ward is very political, it seems.)
  9. 0
    Not a PICU nurse but would transfer my fair share of "why was this kid ever in the ICU?" patients to the floor when I worked in the hospital.

    I would say the most common one that I encountered would be kids with known seizure disorders who had a prolonged seizure at home or increased seizures and their parents brought them to a local community hospital. Said hospital would hear "child with seizure" and immediately sedate, intubate and transfer. They'd arrive to the hospital intubated so would buy themselves an automatic admission to the ICU, where they were immediately extubated and would usually start asking for food and toys. They'd be booked to transfer to the floor the next morning.
  10. 3
    Perhaps not the all-time most stable, but the most recent one was an 18 year old boy when had been vent dependent since her was about 18 months, in for kidney stones. They did what would have been an outpatient procedure normally, but then held him for two days to watch for complications. The only reason for the ICU status was the vent....and his parents or their private duty nurse were there 24 hours a day. I cared for the nurse more than the actual patient....she changed him, turned him, straight cathed him, even took his temp for me. I just wrote stuff down. Hey, not complaining.
    besaangel, SwansonRN, and Esme12 like this.
  11. 0
    I work in Burn but we're PICU/Peds overflow since we take all burnt kiddos as well. (So we're PALS certified, etc.) Most of our PICU admits or transfers are very stable -- usually they admit, then get downgraded the next day to floor. My last admit was a ****** off toddler with an asthma exacerbation. Kiddo spent the entire night screaming his clear to auscultation lungs out, while on room air.

    We had a string of unimpressive adolescent ODs in...Feb? I think. One girl took a whopping ten Pamprin. If you go from ICU status to being turfed to psych the next day, you probably don't need to be ICU to begin with.

    Lots of politics in PICU, too. No offense guys but I kind of feel like our PICU nurses tend to hold on to patients who could be downgraded to peds or even moved to an adult floor (that 60 kg seventeen year-old) -- because they WERE so sick, and staff has gotten attached to them. Which would be okay but those patients are always the first to be suddenly transferred to OUR unit when PICU gets a legit admit. Usually ****** off the parents and the patient.



    KelRN -I did pediatric private duty for a while and, totally off topic, your seizure post made me remember one particular patient that I occasionally took care of. Poor kiddo was basically a vegetable anyway, with a long history of short-ish seizure activity. (Under a minute or so.) Parents insisted EVERY time the kid had anything resembling a seizure (it could be hard to tell), that we call 911 to take to the hospital. The patient had been having seizures every week or so for seven years. Lots of 911 rides. I got out of that case quick because I could tell that their main private duty nurse who had been with them for many years was encouraging this behavior. Sigh.
  12. 6
    Quote from dirtyhippiegirl
    Lots of politics in PICU, too. No offense guys but I kind of feel like our PICU nurses tend to hold on to patients who could be downgraded to peds or even moved to an adult floor (that 60 kg seventeen year-old) -- because they WERE so sick, and staff has gotten attached to them. Which would be okay but those patients are always the first to be suddenly transferred to OUR unit when PICU gets a legit admit. Usually ****** off the parents and the patient.
    You're right, but it's not usually (just) because we like them. It's also because we KNOW them. If they were so sick, they likely have potential to get that sick again if they develop some sort of complication. There have been many times we've transferred to the floor only to have the kid bounce back the next day due to slight deterioration. We recently had a child (10 month old, heme-onc patient, septic shock, pneumos, chest tubes, intubated, pressors, the works) who was finally stable and ready for transfer. Floor didn't have a bed, so we kept him. The next day the nurse noted that he was more tachypneic than usual (50's-60's). Did an x-ray and low-and-behold he had another pneumo.

    We have lower ratios in the PICU. We have monitors and the ability to take vitals more frequently (done q 4 hours on the floor) and assess more frequently for changes in status. Had this kid been on the floor, there's no telling when his pneumo would have been noticed. They have 5-6 patients each compared to our 2. They have nursing techs who take vitals. They don't have monitors that can tell them their patient's RR and SpO2 at a glance.

    We keep these kids because, while stable they are also fragile. As they have just recovered from an illness, they have the potential to deteriorate quickly and often with few or subtle preceding changes in condition.
    WoosahRN, hikernurse, NeoPediRN, and 3 others like this.
  13. 2
    Quote from Ashley, PICU RN

    We keep these kids because, while stable they are also fragile. As they have just recovered from an illness, they have the potential to deteriorate quickly and often with few or subtle preceding changes in condition.
    Some of these kids also stay because we know that one look at their breathing pattern (which is baseline for that kid) would send them straight back to the ICU anyway.

    For what its worth, In my PICU, I find that when kids don't get transferred out, it's more often because the doctors don't want to, not the nurses.
    WoosahRN and dirtyhippiegirl like this.


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