Super RT

I worked for about 8 years in a PICU and finally left about 2 years ago. I have been working in a small community hospital since. The reason I left was due to the large amount of non-accidental head trauma we got. I got so tired of broken children that were only that way because of someone they trusted. Unfortunately I am dealing with my own recent loss (like a month ago) of a pregnancy ended early due to Trisomy 18. Then I get this beautiful child that was thrown away by her father. Her mother is pregnant and I worry that the new child will suffer the same outcome. It makes me so angry that here we are, my husband and I, trying for the last year to have a baby, having it end badly, and this woman allows her precious baby to be damaged. The poor child had scars all over, so even though she didn't inflict the latest damage, you know that she either did some herself or has been allowing it to happen. It just makes me so angry! Further more, when this mother was allowed into the room with the child, she never even looked at her! I would have been all over my child! Then again, there would never be an opportunity for someone to hurt my child that way as I am the ultimate overprotective mother. Give me my smelly old chronic lungers anyday!

Just had a horrible day at work and needed to get something off my chest......... We had a terribly abused little kid that came into out ER today. I wont go into any details, but to say that she will be better off when she passes away. What I really don't get is this. Here I am, wanting to have another child badly, making a child and having to let her go early, while this child was perfectly healthy before this happened to her. Why would you have children if you are going to abuse them? Do the parents not understand that they have been given a gift? That they have something truely special and that they should be protecting her from the world? Not damaging her! Yes there are many children in the foster care system that do not ever get adopted, but if they don't want her, why not give her up to someone who does? To top it off, the mother is pregnant with another child. If she didn't want the first child, why on earth would she have another? This whole scenerio bothers me! Sorry for the rant. Needed to get it off my chest.

If your patient is soon to be extubated, why not wait the 30 min or so until the tube is out? Use your toothettes until they can protect their airway on their own, since they have the same amount of liquid anyway.

As an RT, allow me to comment on this topic. I am reading a lot of different arguments from various posters about this, so let me clear up a few things. 1. VAP happens to patients ON the vent (hence Ventilator Acquired Pneumonia). If the seal was perfect, there would be no such thing. Maybe it would become PVAP (Post-Ventilator Acquired Pneumonia) 2. In a Critical Care Unit, never, ever give an intubated patient something to drink, ice, ect. Would you give them liquid tylenol orally? NO. You would give it through an NG, OG, or g-tube, Right? So don't put ice or drinks in there either. 3. the trachea is flexible. There is never a perfect seal. Anytime you turn the patient, you run the risk of a little leak. It might be a huge leak, but it may be big enough for liquids to get around. Can you imagine the damage a Coke or the flouride in water would do the the delicate tissue of the lungs!! Honestly, you don't want it to be so tight that nothing can get around it. This kind of pressure on the trachea can cause necrosis, pressure sores, weakening, fistulas, etc. 4. The secretions that pool in the back of the throat are not just from the mouth! They drain down from the sinuses and up from the airway. Just because you have an ET tube in your airway doesn't mean the mucocilliary elevator stops to function. It is just not as easy to get the secretions out. 5. The majority of trach patients I have seen have bad lungs, not bad vocal cords. They can protect their airways just fine, they just can't keep it from collapsing. I think I hit upon all the major parts. Please if your patient's mouth is dry, swab it out with a cold, wet mouth swab while suctioning out any fluid that pools. There is my 2cents

Don't smoke 4 packs of cigs a day for 35 years and then get mad at us when the doc suggests that lump on you chest xray is probably cancer. Do not then threaten to sue us because we can't fix it. Don't then have your wife yell at us that you just need a cig and you'll be fine, especially when you are on 100% O2 with sats in the 70's. If you then decide to take off the O2 cause you feel fine, don't expect to be standing long when you take that hike down the hall at full speed. You will get a tube in your airway! If you decide to shoot up crack, and you happen to be eating canteloupe, don't accidently mix the crack and the juice from the fruit together before you shoot up. You will get a big rash, chest pain, and might loose the arm!

Working in 2 major Trauma centers, I have seen way too many beaten up kids! It seems to be worse at the first of the year and half way through summer break. I just think there are some parents who don't have good coping skills. When my son was little, I couldn't understand why someone could be pushed so far, however when my daughter was a baby, I began to get it. She would scream for hours on end with no break. I knew to put her in her crib, where she couldn't hurt herself and walk outside for 10 minutes. She would still be screaming when I got back, but I was calm again and could be rational. It just seems that the parents of these abused kids are either very young or from financially struggling households. I'm sure that stress can escalate the tendancy toward abuse. The way I have found to deal with the parents is to be polite and calm, but not overly friendly. I don't want to be their best friend, but I always worried that the kids could sense the tension, so I decided to put the kids first and be polite to their families. I am also lucky that my sister is a forensic interviewer working with the kids that survive. I can call her and vent when I get off work, and she can call me to vent. I just remember that I have 2 healthy children at home and that I would seriously maim anyone that hurts them in anyway.

I'm so very sorry to hear about your loss. I think the way I get through it is that while at work, I try not to linger in the room after the crisis and let the parents mourn. I go for a walk or try to busy myself with something else, even if it is punching holes in paper. I usually cry on the way home after my shift, hug my babies and have a glass of wine while I write about it in my journal. It is a way to release to sadness, knowing that I will always have a small piece of them with me. I try to also think about the child finally able to play, walk, etc free from pain, tubes, iv's and wires. For the kids that are chronic and seem to spend their whole lives with us, it usually works. I seem to have a harder time with the ones that were previosly healthy and are just suddenly gone. You have to come up with your own way of coping. It might mean a weekly meeting with your pastor, or a journal, but we all have to do something to release it. My advice, spend a little time in the area shadowing another nurse before you decide. That can give you insight into whether or not you can handle it or if it is right for you at this point in your life, before you are committed to working there. Good luck and god bless

At our hospital, only RT's are allowed to perform art sticks. Even if there is just an order for art sticks for labs or blood cultures.

That was my thought! They always tell you not to tap on the glass of a fish tank bacause it stresses the fish. I would imagine that the baby was even more stressed than the fish would be! The problem with telling the nurse manager is that this nurse and I have tangled majorly recently. I'm afraid that if I went to the NM, it would just appear that I was trying to get her in trouble to pay her back. I guess I should just watch her and if she does it again, I should report it then. Hopefully she wont do it again.

I recently witnessed a nurse knocking on the outside of an isolette when a baby was having an apnea/brady spell. She did this multiple times durring the shift. This was a very small preemie. Wouldn't this maybe increase the baby's stress level, possibly leading to IVH?

I work exclusively in Peds and spend the winter every year coughing and sneezing. I get sick every year! If being a pediatric nurse is what you want to do, the colds are just a small downside. In adults, you have to deal with huge diapers and lots more vomit. I would spend the entire year sick to avoid changing adult diapers. There is always something upleasant no matter what route you choose, it just depends on what you want to deal with.

I think it depends on the nature of the patient and their problem. We had a 27 year old once, but he was severely delayed and still saw a pediatrician. I think that the patients that have been in and out of the unit their whole lives are happy to see familiar people and settings. Having a CF patient that has basically grown up in Peds suddenly go to the Adult service is a little scary for them. However, getting a pregnant 14 year old poses all sorts of problems that we are just not accustomed to dealing with. I really think it depends on the patient and the issue.

We have seen a huge increase in MDI/spacer use in our hospital recently. If she is relatively well and not in acute distress, she should do just fine with the spacer. We recommend the patient take 6 breaths with the spacer in place. As long as she is using a spacer with a mask and the little exhalation flap moves upon exhalation, she should be getting the full dose. You can teach her to take big breaths in time by showing her how to breathe each time. If she is in distress, the nebulizer seems to work better on the little kids. (well, anyone for that matter) I would recommend having one on hand, just in case. There have been studies recently that state the MDI is better, but clinically, we see the kids get more of the meds with the nebulizer. I would try to get an AeroEclipse nebulizer setup for her. These create a better particle size for the patient with less waiste into the atmosphere, plus they run over a shorter amount of time. I hope this helps. Good luck!

We have always tried to teach our children to call body parts by their proper names. You wouldn't call your arm a ding-dong, right? So when my son was very small, 3ish, when we gave him a bath we would say things like I'm washing your arm, or I'm washing your member. Well, somehow he missunderstood that word. When his grandmother was giving him a bath one evening, she washed a body part and asked him what it was. Elbow, fingers, etc. When she washed his member, she asked him what part she was washing. He looked at her very seriously and said "that's my Peanuts"!

I also hope to clear up something. RN's don't always get the "easiest" patients and the RT's don't always get the hardest patients. As an RT, I sometimes get the less sick patients in my assignment, as in the floor patients. But sometimes get the hardest patients, as in the ICU. It's similar with nursing. Somedays you get easier patients and sometines you get the harder patients. Even floor patients can be difficult. Trachs, CP, spinal fusions, g-tubes, etc. There are days that a vent patient is easier than a 2year old getting just a breathing treatment, at least they don't fight and run all over the room!:chuckle

Usually starts with low settings, but I've seen the pressures get up pretty high. We also have seen a higher rate of NEC. I imagine the increased amount of air/pressure in the gut could lead to this. I wonder if there are any ongoing studies about this right now. What is SNIPV? I've never heard of that. Maybe we call it something else.

We have seen an increased use of NIMV in our unit and I just worry about the physiologic trauma associated with slamming pressure into the vocal cords like that. I worry about swelling and malcias in the future. Has anyone seen adverse effects associated with it?

I work in a teaching hospital where we get the sick babies (ECMO, MAS, etc) The nurses just don't have the time or the expertise to ru the vent along with all the meds, weighings, baths, feedings, etc. Our nurses raw gasses if they are also drawing labs, but otherwise, the RT's handle this. As far as intubations are concerned, if there is a resident redily available, we will let them try twice. If they can't get it, then the RT intubates. We also handle lots of high risk deliveries and intubate there. The neonatologists are dealing with other issues with the baby. We work with the babies as a team. We are lucky to have the staff so that the baby get a specialist for all major facits of care.

We actually had a baby cannulated twice due to Diaphragmatic hernia that went home. The baby had a g-tube, but from what I understand, the baby is doing fine!

It depends on where you work. Yes I get exposed to some really scary stuff, but I'm at less risk for a needle stick. Depends on what scares you more: inhaled disease, or stuck with scarey needle. I don't think we get harder patients or easier patients. we all get the hard ones, just in different ways.

I can relate to all of these!

As a Respiratory Therapist, I'm a little biased, but let me put in my 2 cents on this. I work in a major trauma center with a high level NICU. All of my experiance in at that hospital mostly in the pediatric department. I think both are equally difficult. It depends on what you like to do and how you like to do it. There are definately differences between RNs and RTs. In a hospital setting, an RN is assigned X amount of patients in his/her department where as an RT is assigned X amount of treatments in lots of departments. The RT may be in the NICU and have the care of 20 patients, but only 5 are on vents and 4 get treatments, but he/she may also be relied upon to go to all preterm deliveries. If one of those vent babies or one of the non-vent patients gets sicker respiratory wise, the RT will spend lots of time at that bedside just as the RN will. The major difference I can see as far as work load is concerned is that the RT is not expected to stay on that floor or at the bedspace of the patients. They see more patients for a shorter amount of time. I enjoy seeing 15-20 patients and spending 15-20 minutes with them. I don't like being confined to a small area of work. In the PICU, I'm responsible for the care of upto 12 patients (that is if I am only assigned the unit) in 2 different areas. However, some of my nursing friends like the total care of the patient. If a patient is needy and whiney, I don't have to deal with it but for just a small period of time. If you are looking for a field where you don't have to work, you probably should look outside of the medical field. We all work hard and are tired at the end of a shift. I agree that you should shadow someone from both areas and decide which one suits your needs better.

You find yourself trimming the flower bed with surgical scissors. You can't find any gardening clippers, but you do happen to have 48 pairs of surgical scissors.

Good point!

I'm more of yes and no. I think that it doesn't matter who is present for a delivery as long as they are a good nurse, but I think that the patient should have an option. My first delivery, I was not in this field and would have been a little stressed out for there to have been a male nurse. I had female OB's, nurses, etc. Durring my second delivery however, when the baby got into distress, the best person in the room was actually a male nurse. As long as the patient gets the option to not have a male nurse if they are uncomfortable with it, I think it' OK