Well, I'm in my final semester of school. Finals are on April 10th. It's so close! I've had a pretty good clinical experience thus far, minus a few nurses who have been less than helpful...but yesterday I was in the PICU for the day and my head is still spinning at how fast everything can go wrong!
I don't have intrest in Peds - and yesterday confirmed it...it's too much. I think it takes a very special person to want to do PICU nursing and I admire them. The nurse I had yesterday was amazing - he was so kind and incredibly smart and wonderful with the patients. I felt completely inept and like a moron acutally. I will spare all the details leading up to the incident ...
But it was a good day, things were going well, I helped a 15 year old kid with Muscular Distrophy who was there for pnuemonia "cough" that was new to me. The RT showed me how to do it, and it was working! I would "cough" him, then suction, cough, suction...etc...this went on for an hour. Finally his Sats were 9o% and he was going to sleep for a while. Right at lunch he had another spell of secretions blocking his airway, and sats were not good. The RN did some deep suction, and that seemed to help. That was at 12noon. We got him on the bedpan and when he was done- he started gasping and had airhunger like crazy -looked at me and said "I'm going to die" I'm like OMG...I looked at sats and they were 80%. The RN turned the O2 all the way up. Nothing. Still 80%. Called the NP and MD in the room and they said lets get him on the BiPap. This was 1208. By this time he had gone from a totally respectful appriciative kid, to fighting, gasping, cursing and lip smacking and making very strange sounds, he was totally confused. Blood Gases taken, CO2 through the roof, and pH 7.13. Yikes! I'm thinking to myself, this kid has tons of secretions that he cant get up -why would we put him on BiPap, it just pushes it down the airway more....even then his sats were still only at 84%. By 1230 they decided he needed to be intubated. His jugulars were about 1/2 inch thick and pounding, pulse at 180, BP 70/50 and he was totally blue, nail beds and everything...he was very combative and his last words to me were "I hate you. F** YOU!" . . . I was scared he was going to die. His father walked onto the unit right in the middle of this- and he was a wreck...on the phone earlier the RN had told him he was doing well, and would go to Gen Peds later today....**gulp** I was kind of a fly on the wall at this point, holding or doing anything then asked me to do. I felt like an ass because I didn't know where anything was because it was my first day on that unit, so I couldn't even run for supplies! So they get him paralyzed and sedated and they asked me to bag him. I've done this before but I was having a trouble getting a good enough seal on his face. Finally I got the hang of it - his sats were finally at 94%. Then out of nowhere the NP who was going to tube him just yells out to someone else "get over here and bag him! You, move!" OKaaaayyy. I know things were tense, and I didn't take personal offense to it - but I felt so helpless. I didn't really know what I was doing wrong - his sats were up to 94% and his chest was rising and falling just fine. So after that I basically just watched as they tried to tube him 4 times and because of his different anatomy they couldn't get it. Sats are now at 60% and it's 12:45 ish. 5 times a charm and the MD got him tubed, the sats still didn't go up more than 87%. NG tube placed, Vent going - and BP keeps dropping. The MD I can see is getting very nervous- and decides (with consent of dad) to put in femoral central line. The juggulars are still huge and pounding, this kids heart was so stressed. I got to see the central line go in, had a front row seat for that. They got the central line in, and meanwhile had 500ml bolus of LR going into peripheral, and Dopamine on the Central line. Now it's like 1:30. Drew more labs, got a x-ray, sats still less than 90%. X ray comes back and the ET tube is 3 cm above the clavicals. NICE. No wonder his sats are still low. His anatomy was so strange that the tube woudn't go all the way down... I had to leave for post confrence at 2pm. So I did not get to see if he ever got better:cry:. The NP and MD were not hopeful that he was going to get better either. I woke up first thing this morning thinking about that kid and how fast he turned bad. I appriciate my child more now than ever. And my hats off to PICU nurses. I could never do it. I just thought It would be good for me to share about the day and get it off my chest. It was a very sad day, but a great learning experience at the same time. . . . OH - and never EVER say "boy it's quiet up here". The nurse about strangled me when I said that - and so of course it was all my fault that 15 minutes later this kid goes down.... (not really, but it was kinda wierd that it happened that way). The MD joked when I was leaving that I wasn't allowed back.. lol.
(not really, but it was kinda wierd that it happened that way). The MD joked when I was leaving that I wasn't allowed back.. lol.