I have only just started my mid program, and haven't been on clinical long.
Yesterday blew me away.
I was with another patient on postnatal ward and midwife was holding a 6/52 twin that was having feeding difficulties (we are the only two in this department at the time).
Babe suddenly goes grey, floppy and RR goes up to 90. Midwife runs to phone with babe in arms to call doctor. I walk in (having no idea what is going on) take one look at the babe and ask to take babe for some O2 treatment monitoring etc. (small hospital we don't even have a monitored nursery).
At the time I was pleased that I managed everything calmly but now I am a mess. I can not imagine myself being that calm if the roles were reversed (I wonder if I am cut out for this??? ).
We have no idea what happened (2 and a half hours post feed) wheezing priror to event but not when I took the babe. Air entry good but tone and colour were very poor. Babe took about 45 minutes to recover properly. Chest xray showed some shadow but bloods were NAD.
So what exactly happened to this baby. Does anybody have any theories?
I can't get hold of my lecturer and I so need to offload this incident with someone I can "hear".
The OP said that the baby is six weeks old, so I think we can rule out GBS sepsis. Probably can rule out CHD too, although I once saw a term kiddo come in at 2 months of age because he apparently had had a PDA that finally closed (unbeknownst to anyone) and he had a pretty significant coarct that finally showed up as symptomatic.
The babe had been discharged at 7 days of age but had two readmissions for failure to thrive.
This was the second readmission and babe was due to be discharged later that day.
I heard today that the babe was monitored overnight in the city, and discharged the next day on oral AB's. Nil further episodes (so therefore nothing is wrong??)
Parents have purchased and apnoea monitor. I pray everyday for that little family.
We almost NEVER readmit a baby to NICU once they go home. I've only seen it once, and it was when the baby had been with us forever, and had gone home the day before.
All others go straight to peds or PICU once readmitted.
We never re-admit to NICU either. The only time I saw it happen was when a kid of ours was transferred to PICU, went home from PICU, was re-admitted to PICU, and then transferred back to us because they needed the bed space.
We DO admit babies that were born normally and sent home for 1-2+ weeks before someone found a murmur/TGA/etc.... doesn't make much sense, since, "technically" our Peds Cardiac ICU "could" handle it. We do have 10 beds for every one of theirs...
eventhough there was no recent feed this could still be reflux or aspiration as different babes have different transit times. the blood sugar is high which could be due to stress or infection especially as your blood cultures have shown a growth. do you know what the white cell count was or c reactive protein? this would also confirm infection. sometimes you don't get a full explaination as why these episodes happen but it sounds to me as if you handled the whole situation very professionally. you need to ask one of your senior grades or nurse practitioners for a debrief. your experience would make a good reflective piece if you are maintaining a professional portfolio.:wink2:
eventhough there was no recent feed this could still be reflux or aspiration as different babes have different transit times. the blood sugar is high which could be due to stress or infection especially as your blood cultures have shown a growth. do you know what the white cell count was or c reactive protein? this would also confirm infection. sometimes you don't get a full explaination as why these episodes happen but it sounds to me as if you handled the whole situation very professionally. you need to ask one of your senior grades or nurse practitioners for a debrief. your experience would make a good reflective piece if you are maintaining a professional portfolio.:wink2:
thanks so much for your support :) i have met up with the midwife that was on with me that day but because we were working we did not have much of a chance to "talk". if we had i think we both would have ended up sobbing. i am planning to use it as a case study for my portfolio - just not sure what angle to take i.e. what should have been done, what could have gone better etc. as far as i rememer her white cell count was normal as was the crp???
when i get off placement and go back to my normal job it's going to be boring compared to this.
I recently had to put a reflective piece together on a resusitation which I felt was carried on for too long. Minefield! However I found a framework which is adapted from Gibb's reflective model which may help you for your case study. Don't want to teach you to suck eggs but it might help. I am in the middle of my masters which entails keeping an indept portfolio, basically if I pee I have to reflect on it:bugeyes:
1. Describe a clinical event and identify the key aspects on which you wish to focus and explore further.
2a. Explain the feelings that the event aroused in you.
2b. What do you think were aroused in other people involved( patient, relative,staff)? Provide an explaination of how and why you believe you were aware of their feelings.
3a. Evaluate the impact of your feelings on your decisions and actions?
3b. Discuss the impact of the resources (people and equipment) or lack of resources on your decisions and actions?
4. What alternative/decisions could you have made? What might the consequences of these have been?
5. If this event occurred again, what might you do differently and why?
6. What have you learnt through exploring this event?
7. What learning needs have you identified through reflecting on your practice?
littleneoRN
459 Posts
The OP said that the baby is six weeks old, so I think we can rule out GBS sepsis. Probably can rule out CHD too, although I once saw a term kiddo come in at 2 months of age because he apparently had had a PDA that finally closed (unbeknownst to anyone) and he had a pretty significant coarct that finally showed up as symptomatic.