New PICU Position

Pediatric Critical Care Columnist · Aug 11, 2016

Congratulations and welcome to our little family! There are lots of threads here that talk about all the things you want to know so you might want to take a wander through the forum. I can summarize for you though.

PICU and the ED have some similarities in that both areas have to be ready for anything and be able to go from cool, calm and collected to Mach 10 in seconds. When there's a code on one of the wards, we have minutes to figure out who is taking the patient, where we're putting him or her and to get the bed ready for the admission... that's in the elevator. If your hospital offers ECPR, there are lots of specific things that happen with that kind of admission as well. Then there are the kids in the OR where things don't go according to plan and now the kiddo needs PICU without having a "reservation". Most days aren't like that, but then there are other days when they're like dominoes!

Our patient population varies by season, similar to the ED too. Late spring and summer bring the traumas, drownings and burns. Fall tends to be a slower pace, except for the severe asthma exacerbations. In late fall the small kids and neurodevelopmentally disabled kids with respiratory illnesses start rolling in. Our management of these kids has evolved over time and we're trying OptiFlow and non-invasive ventilation strategies rather than automatic intubation for a lot of them. These types of admission continue through the winter and into spring. You'll see septic shock year-round. If your hospital does transplants, they can happen at any time and some of them (livers especially) take up a fair amount of resources in the first few days. If your hospital has a cardiac surgery program but not a dedicated cardiac ICU, those surgeries are a constant and there could be 2 or 3 admissions a day. Depending on the concentration of African American population in your area, you may see kids in sickle cell crisis fairly frequently, especially in the summer, because dehydration is a serious thing for them. Easter and Hallowe'en might bring DKA with them. And economic downturns usually bring a spike in non-accidental traumas.

Meds? Analgesics, sedatives, anaesthetics, anticonvulsants, anticoagulants, PPIs and H2 blockers, salbutamol, insulin, electrolytes, TPN, vasoactives, antibiotics, antipsychotics... pretty much the full gamut.

Be prepared to be assigned stable, single-system patients for the first while until you get your sea legs. It's not a reflection on your skills, but a gradual immersion into this wild and woolly specialty.

Plutonium261 · Aug 25, 2016

Just wanted to say thank you so much NotReady4PrimeTime for all of the great info. I am ecstatic! I just graduated a couple of months ago and got picked/hired into a phenomenal new grad RN residency versant program! I'm so excited, and a little nervous, but excited! Anyways, thanks again and I too will continue to look around the forums for other great information and tips.

guest940422 · Sep 1, 2016

Not ready for prime time really nailed it, it can vary greatly from hospital to hospital. I've seen PICU's who made every patient with an ET tube a 1:1 and others that would give you 3 kids on pressers. I'm sure you've sat on plenty of ICU patient's while waiting for beds (and probably cursing out the PICU) so you know what it's like to manage some of them. It gets tricky with the post ops who weren't supposed to end up there, or the long term admits who start having extra complications. If I had to build on what you've already read it would be to never trust a DNR. I've coded at least 100 kids who's parent's changed their minds at the last minute... and they can. Be prepared to work with a "grieving" parent putting on a show at a shaken baby's bedside, they often wait to see if the child survives to arrest the parents so they don't have to change the charges. And focus on your assessment skills because the subtle changes you notice early are going to be what prevents your patient from arresting.

You're going to do great! I wish my unit was getting new hires as eager as you.

sergel02, BSN · Sep 12, 2016

I recall a fiend telling me the to three things she would see in her few months working there this year were MVAs, congenital abnormalities, and abuse. But you do see the whole thing. The picu she was at also had like a half step down part for less sick kids but too sick for the floor.