The LEAST critically ill kid you've cared for in PICU :)

[meanmaryjean]

So last night I admitted an eleven-month old fro the ED into a PICU bed for acute asthma. The floor doc declined him due to his 'instability' and 'acute distress'.

The first HOUR this kid spent in the PICU was spent jumping up and down in the crib- without a break, all the while laughing and carrying on. He then collapsed in exhaustion from all the bouncy-house action in the cage crib, and slept peacefully- satting 100% on room air with clear breath sounds - the entire rest of the shift. Until I woke him up for Orapred- which (mixed with a little pancake syrup) he chugged down like a cold beer on a hot day.

So- I am proposing a light-hearted thread devoted to those 'Why is this kid in the PICU?' moments we all have.

Ready...set...GO!

[meanmaryjean, DNP, RN]

Aaah, sorry, didn't mean to offend. I guess I should have added the caveat to my original post that I was mostly frustrated with the politics surrounding my particular hospital's PICU, of which I don't want to get too in-depth for fear of outing myself to the wrong people.

The ability of a sick-sick or sick-stable child to crump suddenly is one of my unit's biggest collective fears since we've become overflow (we do pediatric burns, big burns in theory but in practice anything big and under 14 years gets life-flighted to Shriner's so), so I do *understand*...I was mostly just using this topic to inappropriately vent about a particular situation. I'm sorry!

Inappropriate vents are our FAVORITE kind!!!! No worries!

[meanmaryjean, DNP, RN]

My new standards of "You do NOT need a PICU bed" is this: Anyone who can eat chicken fingers and ranch dressing, coke and fries? No PICU bed for you!

[umcRN, BSN, RN]

at my hospital all pre-glenn cardiac cath patients have to stay overnight in the CICU for observation. I admitted one today, big fat chunky 4 month old who w/in the first 30 minutes of waking up from anesthesia ate SEVEN OUNCES of formula, thats almost unheard of for a cardiac baby. Once he was allowed to not be flat (6 hrs post cath) he was dressed and strolling around the unit in the wagon flirting with all the nurses.

Very very sick obviously

[HazelLPN, LPN]

The PICU I worked in was generally very high acuity, so we shipped off kids to the floor as soon as we could...except when politics came into play.

One of the surgical attendings had a daughter who had CF...the mildest case I've ever seen. Even on her sickest days when she came in for a clean out, there were kiddos up on the pulmonary floor who were in much worse shape than she was. She never went to pulmonary, always to the unit to be cared for only by certain nurses. After her clean out, she would be discharged home. When I would do my charges she always came up as a 1:3 care...which means she needs to go upstairs. It never happened.

Only certain beds were acceptable. Bed 8 was her favorite. Bed 1 was okay too. Don't even think about Bed 11-16. Bed 25 will do in a pinch, but it was only temporary. Mom (an RN) and Dad did most of the care...all the PDs, meds, treatments. All I had to do was chart and occasionally do a little nursing here and there. She was a sweet little girl, although she was a bit spoiled. She would always say "Please and thank you", but expected to get what she wanted when she wanted it. Taking care of her required not so much the skills of a critical care nurse, but as a successful waitress and/or cruise director.

Other nurses complained, I just played the game and enjoyed a very easy assignment/break whenever I took care of her.

[umcRN, BSN, RN]

My new standards of "You do NOT need a PICU bed" is this: Anyone who can eat chicken fingers and ranch dressing, coke and fries? No PICU bed for you!

And yet if they have obstructive sleep apnea from all these chicken fingers and need bipap at night...they will be found in my icu, because the floor can't do bipap

[meanmaryjean, DNP, RN]

Our floors do Bipap (if the kid is a home bipap) but will not take home vents - no matter what. So we get every home vent kid who comes in for T&A, scolis, heel-cord lengthening......

[umcRN, BSN, RN]

Our floors do Bipap (if the kid is a home bipap) but will not take home vents - no matter what. So we get every home vent kid who comes in for T&A, scolis, heel-cord lengthening......

Same here about the vents! (clearly if the floor won't do home bipap, they won't do vents) Except i'm in cardiac ICU but if an old MRCP PH-er comes in for hip surgery it's us that's got him! And all the other cardiac home vents, but the picu is the same of course, they get all the non-cardiac home vents

[MeganNYRN]

I worked in a PICU that took every pt that had a VP shunt not just malfunctions. If a pt coming in for an t+a or appendectomy etc had a VP shunt they had to stay in PICU through discharge. Apparently due to a sentinel event but it seemed silly to have kids who were fine hooked up to monitors all the time in a PICU bed.

[umcRN, BSN, RN]

I worked in a PICU that took every pt that had a VP shunt not just malfunctions. If a pt coming in for an t+a or appendectomy etc had a VP shunt they had to stay in PICU through discharge. Apparently due to a sentinel event but it seemed silly to have kids who were fine hooked up to monitors all the time in a PICU bed.

There's always that one event that ruins it for the rest of them. Never mind improving education for the floors and working to make the hospital stay better for the patient, nope just tie them to an ICU bed/monitor that their insurance probably won't pay for and hope that no traumas come in!

[Mauletta]

I'm not PICU, but worked in Pediatric Level ! Trauma for years. I sent a teenager to the Burn Unit one night. Report was high temp flash burns to the face, 9% BSA all to the head, with airway involvement. He was sedated, paralyzed for transport, and coming by 'copter. I've got sterlie sheets on the bed, we're all gowned up and expecting, well .. a burned kid. The 'copter crew comes strolling through the doors, chatting to each other (tip off #1), I don't smell "that smell" (tip off #2).

This kid gets over to the gurney and my attending and I just look at each other and at the same time say, "Where's the burn?". Literally. This guy had one single strip across his forehead that was red, one little bubble of blister, 1mm X 1mm at the left end. No airway involvement at all (and he had a full mustache, no singed hairs). He went up to Burn to let the Vecuronium and Versed wear off so he could be extubated and observed over night. He arrived in the ER at around 22:00, they were gone and driving home by 09:00 the next day.

[anon456, BSN, RN]

A suspected rocky mountain fever patient, transferred from a small rural hospital. Found to have a common virus (causing the fever) and bedbugs (causing the bites).

[meanmaryjean, DNP, RN]

We get all the scolis overnight on their surgery day. No biggie. Had a teenaged girl several months back who had a very long anesthesia time (like 13 hours). Needless to say, she was a wee bit loopy. She kept saying, "Wasn't that sweet of him to fix my back?"

We assumed she was talking about the surgeon, agreed with her over and over. Mom calls us into the room about 2am- convulsed with laughter. She says, "Ask her WHO fixed her back." So we did.

"Barack Obama - and he's a very busy man!" was the answer.

Mom of course filmed this hilarious exchange, and I'm sure it'll be drug out at this girl's prom or graduation party.