qcumba

Hi NICU nurse here, sorry if I'm invading your forum... We recently had a very sad loss in my unit, one of our micro's, a former 25wkr, 820g at birth we fought really hard along side him and his parents to get him to discharge -his initial stay with us was fairly uneventful apart from a PDA ligation, struggling to wean him from his O2 due to BPD, and a couple of day prior to his planned discharge date he arrested due to a reaction to the eye drops used in his ROP exam,but after a day on the vent he was extubated and after a very long 105 days we sent him home, he was the sweetest little thing and we loved seeing him on his monthly visits to get his synagis shots.Then a couple weeks ago just prior to him turning 6 months old, the lady looking after him while his mom was watching thier older son play soccer,phoned his mom to tell her he was "breathing funny", his mom rushed him to the paed,as they entered the paeds office he went into respiratory arrest,mom performed CPR and baby started breathing again at which point the paeds receptionist grabbed him and ran with him to our unit - the paed was in theatre for a caeser - we dont usually re-admit to our unit especially now during RSV season but we were closer to the Dr's rooms than ICU/ER, Any way by the time they got to us he was in full arrest and it took them about 35 min to get a pulse, he was unresponive, in renal failure - he was basically passing blood,extremely oedematous etc but as far as his parents were concerned he was still there, so we were aggressive and had him on the osscilator, on pressors etc and over the next 2 weeks we watched him very slowly improve, he started passing urine and starting to respond to pain, but then all responses became decerebrate and a CT was done and there was extensive ischeamic damage,very little healthy brain remained... After the Dr spoke to the parents and explained he prognosis, we began weaning his ventilation, his parents went home to thier other son - they stay out of town and didnt have anyone to look after him - and it was left to me to wean him down to minimal settings and then to wait for nature to do her thing, I cannot tell you how painfull that was for me, to watch this little human, who I admitted into our unit as a tiny 820g baby and to then be the one to watch him leave this world, it was incredibly hard, I'm fairly new - qualified for 2 years - so I haven't had all that much experience with this sort of thing. the hardest part for me was giving him a bath wrapping him in a blanket and placing him in a bassinette, covering the bassinette and taking him to an empty room for his parents to see him when they came - they didnt get there in time and only arrived after I had left - but fo me leaving him alone unclothed with just the blanket over him at the time felt aweful,I couldn't bear the thought,as silly and irrational as it sounds, that he was cold and alone, I sat there with him for a few moments a wept a bit, and then I went back to my other assignments. Eventually at shift change, the thought of him going to the funeral home "cold" and un clothed was still bothering me so I came home and got him an outfit and blanket,which we dressed him in before his parents came. this and going to the funeral the next week with my colleagues helped, we still talk about him often and I think that helps us all, I feel the day a child/baby/patient's death doesnt affect me in some way, is the day I find something else to do or take a long vacation... One thing that still bothers me tho, someone out of the profession said to me afterwards that I, in essence by weaning the vent,basically suffocated him....that really hurt, and while I understand all the theory and reasoning,and that to continue at full ventilation was cruel,that there really wasn't any alternative, at the back of my mind I still feel like I suffocated him.... again sorry for hijacking your thread and I probably havent helped you one bit, all I can say is find someone at work who understands and chat with them, laugh about all the funny little things the patient did,try not to focus on remembering all the bad,easier said than done I know...Hugs:heartbeat I hope you can find peace and know that you really did everything you should have done, theres nothing to gain from blaming yourself :redpinkhe P.s. We never found out why he arrested in the first place, but the xrays suggested aspiration.

Hi there, Just dropped by to let you know how our little guy is doing, he is still npo, on tpn and went for his secondary closure last week the surgeon says all he bowels looked good, no necrosis or any thing, so for he is doing well, no complications at all, passing stools like a champ, Dr is waiting a couple more days before we can start small amounts of feeds. he is of course very crabby and hungry but otherwise ok. I am so pleased :) I hope it stays this way

Hi there, thank you Averysangels, will be in contact if I have any more questions, sory that I have been quiet, have been off from work with flu for the last few days, so am a bit out of the loop as to what is happening back at work, but when I left on Thursday, baby had been extubated day 1 post op and was doing ok, was on TPN and we were waiting on his first stool before they went back for the second op to close the abdomen. I hope to be back at work tomorrow, I really want to see how he's doing. thanks again to everyone :)

Thank you prmenrs, for that referance and I will do a more specific search as well,I will definately be back I'm sure, asking questions is kinda my thing. And I will try and keep you updated on how our little guy is doing Thank you again to all of you and if anyone has anything more to share please do :)

thank you for all your replies and advice, I had a giggle at the tact and the emphasis on conveying said advice with respect :) us South African's have very thick skins and dont get offended easily,so none taken, I just appreciate the insight you can give. I have been trying to do some research but most of what I could find was mainly aimed at parent's not much for us as nurses if you could give me some pointers that would be great. As far as why we are admitting the child in our facility, well now it's my turn to attempt to be tactful,the only other hospital in town who has treated these kinds of cases,is a state hospital and I personlly wouldntwant my worst enemy to end up there,if you can think of the worst developing country kind of facility this would be it,its a filthy disgusting place. Whereas our facility while small and unexperienced in caring for these kinds of cases, are a private facility with everything he could possibly need and the resources to get what we dont have . That is sad I know but now Im getting off topic The paediatrician on the case has been in contact with a professor who is experienced and has got guidelines from him. Baby was delivered yesterday at 38 wks via ceaser while I was off, he has gastroschisis and not an omphalocele,he was operated on straight away, they were able to get the intestines back into the abdominal cavity, but have left it open to allow the swelling to go down,he is ventilated and so far things are going well,its early days tho so we will have to see how he does. thanks again for your help,

Hi, I was just wondering if those of you in bigger units have seen this condition before? we are due to be admitting a baby this week with suspected gastroschisis or omphalocele, it will be the first time we will be having a child with either of these conditions, in fact its a first for the Paediatrician as well, we are a very small unit only 6 beds Basically I would just like to know in general the length of stay we can expect, how long typically do they wait before the first surgery and are they intubated and ventilated straight away at birth or is a wait and see situation? thanks

We use axillary temps on most of our patients, Bladder temps on our open hearts and our very untstable pyrexial patients get rectal temp probes which connect to our monitors

Hi,yes I tend to agree,I don't really think it's the best option either,sometimes we have to use huge doses to get the patient out enough to intubate,that we end up with a patient with no blood pressure, very often they don't have much of a bp to start with! but to get our physician's and older RN's to change thier way of doing things is almost impossible.

Ok I seeI have caused some debate, let me clarify what I mean't, We use a stat dose of 10-15mg midazolam,intubateand then once the patient is intubated and ET is secured, position checked etc we commence morphine and midazolam infusions titrated to effect, they usually run at 1mg/hr and 2-3mg/hr respectively. Now I must say that I haven't seen any patients have an MI, usually our biggest problem is hypotension.

Reading through all these replies, it seems that we are the only unit who uses Midazolam/Dormicum, for intubations,and then dormicum and morphine post intubation for sedation, is there anyone else who does this?

To a 9 year old brat, post cardiac surgery, after a long night of being ordered to lift/ lower the head of the bed, fetch that, bring this,refusing her oral meds and being a general PITA..eventually just prior to shift change, while I am busy getting everything finished before handover she say's "put the bed down" I initially made as if I hadn't heard her, but when she ordered me do it a second time I said "All you have to do is ask nicely, say please and I will lower your bed with pleasure" her reply was to stick her nose in the air and refuse to be polite, her bed was never lowered... by me anyway

Hi from a fellow south African :) Good luck with the rest of your studies :)

Thank guy's for all your input,sounds likethe manufacturing of air out of nowhere is a common problem with these pumps then, at present we are using the Baxter pumps,the colleague I think, and they are soooo heavy and you can only run 3 infusions through each one, and being in ICU the patient's bed space starts to look very cluttered when you have many infusions running at once, so it looked like the Space pumps would help with that. we will see how the trial goes, it's only fr 2 weeks,which isn't long enough in my opinion Thanks again

Hi, we ar trying out these B.Bruan SPACE pumps, and I was wondering if anyone else out there has used them and what their thoughts are, firsthand they seem great,but we have only just started the trial so haven't had a chance to find fault yet. What are your thoughts?

To be honest, I actually am not sure why we don't leave our pt's on thier sides after rubbing them, we do it with our baby's and kids but not the adult's - our unit is mixed we get all age's. I think we're just scared of the risk of extubating the patient, and how do you restrain when the patient is on thier side? Do you turn on your own? Because even if I'm lucky enough to be 1:1 I couldnt turn most of my patient's alone, and there is very rarely any one to help that often.