elizabells

Okay, I know I'm terrible, and I'm sorry you're having frustrations with this (and I would be BOILING mad if I were you) but I'm giggling like a fiend right now. It's late, I guess. Nothing about this yet in NYC. But our blood bank suuuuuuuuhhhhuuuuuucks at all times, so I'm not sure I would notice if they got any worse.

The tally from the last M&M was 18 in a month. Which more than doubled our previous high, which was 8. We took the other NEC twin off the other day 2/2 a bad bleed. On the bright side, I had the most rock-star cardiac the other day. Extubated less than 24h post op, eating shortly thereafter. Woot!

Jesus mercy. Now we have a neonatal leukemia. Our fellow told me today we've had fourteen deaths this month. The NEC kid died. We got another bad, bad NEC from an OSH a few days ago, and today they brought in her twin, also with terrible NEC. The hell is going on out there?

So in the past week, we've had: A former 36wk TGA who was grown for a while, full feeds, used to take him off the monitor and walk him around. Then we did his arterial switch. Died suddenly just after the OR. A harlequin ichthyosis. Died. Conjoined twins who shared a liver and one three-chambered heart. Died. A growing preemie who went from full feeds to his intestines in a silo, they're all dead and the surgeons couldn't fit them back in. Peeing bright red blood, K+ of 9 with rhythm changes. Gonna die. A 6mo old with MAPCAS who was initially deemed unrepairable, then decided to take him to the OR but with a 40% chance he'd make it off the table, made it through, been two months since then, got a Nissen a week ago, was sitting in his stroller today on room air, shrieked once, asystole, coded, shocked, lido, epi. Died. Whiskey. Tango. Foxtrot.

Well, we do have a new TEN PAGE flowsheet for PCAs and drips... that'll fix everything!

yappy, the thing that's frustrating is that we've DONE all that. JHACO hit us hard on our (total lack of) pain management this summer. The issue is a total culture change at this point. The knowledge is there, but the will is not.

You guys, if I told you how hard I had to fight and kick and scream today to get ONE DOSE of PO Tylenol for a kid who'd just been circed, who was lying there going ballistic, PIPP score of 10, with no fewer than FIVE doctors at my bedside watching him lose his mind, all "Oh, he just wants his pacifier" and "Maybe he's hungry!" No, maybe he just got the END OF HIS member CHOPPED OFF. Jesus mercy, there are three residents and two attendings who are very, very lucky they made it home without having an isolette thrown at their heads today.

1. PLEASE stop pretending you understand more than the most basic English. The doctors are starting to think I'm crazy when I call them back for the tenth time to explain the gravity of your child's condition to you because you keep saying "Okay" and "Yes" when they ask if you understand what they've told you and then ask me the most baffling questions the moment they leave. I know you're scared, I know you don't understand what's happening, and I know you don't want to look foolish for not speaking English. But it's okay not to speak English. This is why we have translators. 2. When you come to visit your child with a bandage on your arm and you tell me you just came from the ER because you have an infected sore for which you are taking Keflex, please don't get huffy with me when I ask you to wear gloves to touch your extremely sick child. 3. When I carefully explain HIPAA to you for the second time in under five minutes (seriously)and why it means you can't wander up and down the halls peering at every other baby in here, do not tell me you are looking for a clock. I promise there isn't one in the isolette with that 500gm preemie.

"If the smell of smoke coming off you can knock me, who has smoked a pack a day for ten years, halfway off my feet and make me instantly nauseated when you come to visit your just-had-open-heart-surgery BABY, perhaps you should look into changing your shirt when you get here." Oh wait, I totally did say that. But, you know, nicer. I say this all the time. Sometimes it actually gets them to stop complaining for, oh, at least a minute and a half.

Oh, bitty, they hate me too. I got called into the principal's office and warned that my Pyxis usage was being monitored because I actually, you know, GAVE PRN's when they were ordered on an ECMO baby.

Pain meds for chest tubes? Oh, that would be nice. Most of the time I can't get them to order meds when they're putting the chest tube IN, like not even lidocaine, let alone Fentanyl or somesuch.

Man, we don't even let moms put their own breast milk in the fridge anymore. Like Steve said, triple scan with the barcode dealie. When a junior nurse screwed up EBM, they got suspended. Once it happened to a senior nurse, oh, hey, it's a SYSTEMS error, let's make a new policy. Siiiigh.

Nope. They were off for two weeks, paid. I do know of one woman who was actually infected while working, and the strain was identified as originating with a particular patient. She had multiple abcesses that had to be I&E'ed, and it took her a really long time to clear. Our ID people told her if she didn't clear she wouldn't be able to come back to work and probably wouldn't be able to work anywhere, ever again.

I promise that it's not. We just passed JCAHO, and while we did have to make some changes, this wasn't one of them. ALL of our cares on 99% of our babies are at 8-11-2-5, and the general practice is to do your gavage kid first, if you have one gavage and one nippler, so that if your nippler is slow, your gavage kid doesn't get off schedule. Nobody holds their gavage feeds. Not the younger, "poor work ethic" nurses, nor the older "supposedly awesome work ethic but still often found sitting watching YouTube videos or shopping online or taking multiple personal phone calls" nurses. People are people. Many of our younger nurses don't even take their full lunch break, while more than once I've waited over 90 minutes for a senior nurse to deign to show back up on the floor.

Or with every heelstick/IV start/diaper change: If you'd stop KICKING ME this wouldn't take so long and I'd leave you alone again!

I hate how they don't get logic! I find myself patiently explaining stuff to my kiddos, like, every shift, but they NEVER LISTEN.

For. Ev. Er. Or until their insurance tells us to quit screwing around and send them to LTC, in which case we try to get them to NC. Trachs only for airway issues or long term (like, MONTHS) intubation.

The smallest ones do; the larger size do not. And yes, the rise is very low, I guess to accommodate umbi lines.

We use cuddlebuns as well. We refer to the flat, white, mini-chux as weepees.

We start to trial off when they've been kicking it on 21% for a while without issues. The MDs sometimes ask us to, sometimes we just give the kid a shot if we know them well and trust them. Or if a kid is an absolute maniac, after the fifth time they rip it off their own selves in two hours we might just leave it off and watch closely. If they're that frantic with it on, sometimes they do better without it.

Aw, my great-grandfather's name was Major. It was an Ellis Island Americanization of (something like) Meier.

My understanding is that their heads do go back to normal. I can spot the CPAPers on alumni day by their poor noses, but their heads look pretty okay. We haven't had an ECMO in MONTHS! I miss it too!

I work in the unit where bubble CPAP was invented, lo these many years ago. We use Hudson prongs with either the provided hat or stockinette. You just have to pay attention to the bubbling, and check it now and then. That's the first thing we look at if the kiddo starts to desat or whatever. I find that when we do have kids on IMV CPAP, the vent just alarms constantly because there's never a perfect seal and people start tuning it out. We do have a ton of toaster heads, and when the kids are stable enough our OT/PT start working with them on positioning to try to mitigate it, but there's not a ton you can really do.

I'd wait and see what your unit's protocol is. Ours has a Littmann for every baby, kept at bedside, no sharing unless it's an absolute emergency. Our cardiologists do use their own, and they rotate around the entire hospital, which has preemies up to "kids" in their 20s, so they have Littmann pedi steths. They use the smaller side for our kids and the bigger for the bigger kids. One actually used his on *me* the other day when I got a little overstressed and tachy the other day, but that's another story.

And never disconnect GT tubing to give a med to a screaming baby. Pregestimil mixed with amoxicillin doesn't wash out of scrubs.