Funny

PDA ligation

I just got home from almost a week in the NICU (2 more weeks till graduation, btw).
One of the many things I got to be a part of was a PDA ligation on a neonate.

What is it:
The ductus arteriosus is a temporary fetal blood vessel that connects the aorta and the pulmonary artery before birth. The ductus arteriosus should be present and open before birth while the fetus is developing in the uterus. Since oxygen and nutrients are received from the placenta and the umbilical cord instead of the lungs, the ductus arteriosus acts as a "short cut" that allows blood to bypass the deflated lungs and go straight out to the body. After birth, when the lungs are needed to add oxygen to the blood, the ductus arteriosus normally closes.
However, when it does not close, a PDA ligation is needed.

How to diagnose PDA:
Diagnosis is most often made by detecting a heart murmur heard through your stethoscope. Tests such as a chest x ray,and ECG determine the severity of the PDA.
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When I found out I was going to get to go in on the ligation I was waiting on it all day! It's kind of like when you were a kid on Christmas Day waiting and waiting....and waiting... for mom and dad to say you could open gifts. It was like Christmas for me! But when you're waiting on the one and only neonatal cardiology surgeon in town, you're on his time.


I compare the RT department here to a fishbowl because it is surrounded by windows so that if you go into the department you are still able to see babies and their vitals.

Anyway. I was sitting in the fishbowl reading (I may or may not have been starting to nod off because all the lights are dim in the NICU)when I thought I overheard someone say "PDA" my head popped up and I looked around to see if anyone else heard it or if I was just dreaming. I figured if they did they would start walking over to that neonate. Because, after all, who HASN'T been waiting on this all day?! Nobody acted like something freaking cool was about to happen, but I walked out there anyway. And guess what! It was time!!!!!! I saw the nurse starting to scrub up to prep the patient. YYEEEEEEEES! I went and got the RT I was following because I was too scared to be in there without him in case something happened. I didn't want to shit my pretty greys anatomy scrub pants(shutup).

We scrubed up: gown, gloves, chef hat, mask. This is now a sterile area. No more fun and games.

People in the room: a few scrub tech people, anesthesiologist and his carts with goodies, RN, me and my RT, and the surgical cardiologist.

The baby gets turned to his side and secured in a comfortable position. Everything gets draped with blue sheets. *Anything blue is sterile. Don't touch it. The ceiling and windows will crash in, fighter jets will land right beside you and you will be taken hostage due to your ignorance*

The anestheologist gives his meds so the baby is comfortable and doesn't feel any pain.
Surgeon marks the spots on the babies skin with a marker.
Someone cleans and sterilizes exposed baby skin. Then it starts.
The area is cut open and the surgeon does his magic and uses the worlds smallest stapler to close the PDA. Then sews up the opening.

The whole time this is happening we are monitoring the patients vitals. If his sats start to drop or if his heart rate or blood pressure get out of normal limits we are perfectly positioned at the starting line to take off and do OUR thing. The babys sats do drop into the 70s and the bp raises. We change some settings on the vent and continue to monitor.
Everything slowly normals out.
Doc calls for chest xray.
Nurse tells another nurse (who is not scrubed up) to call radiology for cxr stat.
Surg techs start to pack up their stuff to go.
Radiology comes, I leave so I don't get nuked.
Film comes back. We look and you can see the little metal staple.
There was a very small pneumo on cxr. If the pneumo is large enough, a chest tube will need to be placed during the pda ligation. But we didn't have to do that this time.

Yes it WAS freaking awesome and I left with clean scrubs.

Some pictures I found for you:

nicu clinical mon

Lots of babies today.
42 babies in the unit.
Tiny whole little humans.
Feet as small as my fingertip.
The other student with me changed a diaper today
for the first time EVER
and it was on a 2 pounder.

Lots of PDA ligations.
I thought it was more rare than what I saw today.
Substernal retractions.
Heart murmurs.
5 toes.
Helped with 5 C-sections.
Have yet to help with a vaginal delivery.

Used lots of bili lights, need to do more research on that.
As well as caffeine given IV.

Then saw a healthy birth.
The baby seemed HUGE!

For now....
Sleep.....

Getting closer

The time I have left before graduation keeps getting less and less. Which, I guess is a good thing. We had our pictures taken last week. The pictures are for our graduation announcements that we will send out for invitations. I thought they turned out pretty good. I even thought about ordering a few extras so I could give one to my mom and dad - until I looked at the prices. I cant even get one single picture for less than 30 dollars, regardless of the size. So........ I may be reconsidering that decision. Students are poor. They need to change their prices! Oh, BUT the thing that I really did like about the pictures was that they took one single picture of each student with just a plain white background. That one is so we can use it when we apply for our state license since you have to add a picture. And the licensing boards can be pretty picky about the picture (and well the whole process for that matter). Anyway,there will be a big framed picture of everyone that will be hung on a wall in our classroom. In a way thats not a big deal, but then again, I do feel kind of honored because we are the very first graduating RT class this school has had. So every class that comes in from here on out will see our pictures hanging on the wall (like we are starting the tradition sort of).

I have had 3 weeks off (excluding the state rt convention last week). My clinicals start again next week. These clinicals will be different from the past two years, though, because it will be in the pediatric and neonatal units. Granted I have had a few clinicals in a pediatric unit in the past, but let me enhance the word "FEW". I have A LOT to learn. And that fact in itself scares the living hell out of me. Why? Because I graduate in ONE month. WHAT IF I'M NOT READY TO GRADUATE. WHAT IF I DON'T WANT TO WORK AN RT SHIFT ON MY OWN BECAUSE THEN I WONT HAVE ANYONES DECISIONS TO RELY ON BUT MY OWN. OH GOD!


Oh god how am I going to pass my test? Have I studied enough? Do I know enough?


This is getting stressful................

State Conference - OSRC

Just got back to town from the state OSRC Conference...

The conference was at the Reed Center.



















Let me tell you..... it would have been much better if students could actually use the CEU's. There was one presentation that stood out to me. It was a lecture about HFV - High Frequency Ventilation on adults. I learned quite a bit from the speaker.

For those of you who don't know, last year at OSRC, our class played in the state sputum bowl. We entered the competition thinking we didn't know NEAR enough to actually win, but we did it for fun. Well, we ended up winning the entire competition and got an expense paid trip to California this past December for the National Respiratory Conference. That was sooooooo much fun!


So........... this year we entered the competition again - and won - AGAIN! Can you believe it!? The national conference this December will be in San Antonio Texas.

We graduate NEXT MONTH!!! Cant wait cant wait cant wait cant wait!

Only a few more months......

Ok, so its been a while since my last post. I guess Ive had time to calm down from the pissy post".

We only have a few months left until we graduate! Graduation day is the last day of July. Looking back, it has gone by so fast. But looking forward, graduation couldn't come fast enough.

We have been preparing for the board exams quite a bit, actually. At least once a week for the past year we have done the kettering review together as a class.
This summer we are going to a kettering review seminar and we are also going to a Persing review seminar. So, yes I am nervous about the boards, but I am pretty optimistic about all the review we will be doing.

Another change coming - We are moving to IOWA!! Matt is going sooner than I am since I cant leave until I graduate. It will be 8.5 hours away from home. So I guess I will be looking for hospitals up there. EEEK! Scary to think about......

Pissy Post

*Before you read this, know that I am not a mean person. This is me venting. I will return to my normal happy bubbly self after this post*



I was pissed at my last clinical. Before I gripe about what happened I want to say that I do appreciate clinicals and the preceptors and the RT directors that let students do clinicals in their hospital. I know that even the mundane things can create a learning experience. That being said, my class goes to hospitals all over the state. We go to both small hospitals and several of the biggest ones around. Actually traveling 2 hours for clinicals is not abnormal for any of us. Anyway, as you all know I am in my final semester of class. This semester is CRITICAL care III and Neonatal and pediatrics. The hospital I have been at for the past month does not specialize in children so my goals there were all critical care related. Critical care III - this is the THIRD semester dealing with critical care. We are not just starting it. For all our critical care rotations we have to be in the ICU. We have had LOTS of training, labs, reading, tests etc for critical care and mechanical ventilation. So the point of the clinical for critical care is to provide the hands on skills and training. I NEED to SEE the vent, I need to see the patients in ICU. I need to know why certain settings are what they are so that when Im NOT a student I will know what Im doing.

Anyway I get to the hospital at 545 am. They put me on the regular adult floor, not ICU. This is the first thing that frustrated me. I said that I am in critical care rotations and that I need to be in ICU. And you know what they told me? They were TOO BUSY and they needed me on the floor. You know what? I really dont give a flying &^$# if they are busy or not. If they are THAT busy, HIRE me and I will do whatever work is required of me as an RT. But today I am a student in this hospital and I am not here for free labor. I am here to LEARN period. I am not here to get half of an RTs workload so that you don't have to call in someone else. I dont care if there are only 2 patients in the ICU. If that is the case, let me do ICU rounds FIRST and foremost, THEN I will help out other therapists just the same as anyone does.

Anyway, I didn't want to start crap so i took my patient sheet and we went to the pyxis to pull meds. She handed me all the meds that I needed and she said this is for room whatever number, she looks at her sheet and says "Wait... wait wait.... that person takes their treatments with bipap so you cant do him"

HOLD THE &^$%^&*^ PHONE!!

I said "I can do bipap as a student". Afterall, I have done lots and lots and lots and lots.......... of bipap treaments! She acted like I was out of my mind. You should have seen the look on her face. She said "No. Unless it is on your license you cant do bipap." Please tell me you are kidding me. You have to be kidding me right!

Me: "I dont have a license in this state.... I am a student." (I said in this state because I AM a licensed SRT-student respiratory therapist in the adjoining state because I live close to the state line. And yes, on that license there are no limitations, including bipap treatments.)

RT: eyes got big "OOOOH.... NO then DEFINATELY NOT"!!!!!


First of all. WTF do you think students do? Stand around holding a book in the hospital twirling their hair. Appearantly she thought all students could do were neb treatments. Even students in thir final year, final semester.

Second, according to your theory if I cant do bipap treatments because its "not on my license", then guess what, I cant do nebs either.

I bit my tongue and gave her the bipap patient and took all the nebs. I had one patient left and was walking down the hall to do it when I see my preceptor sitting on her ass in a chair out in the hallway. She was done with her patients and was sitting there doing NOTHING while I finished her scut work. Not to mention she didnt even give me a pulse ox to use for the day because "they cant be checked out to students" Tell me HOW THE &^%^ am I supposed to document all of a patients vitals without the 02%? I am working under YOUR license so YOU should really care about that too!!

By the end of the day there were FOUR extubations in the ICU that I didnt get to be a part of. I didnt even get to stand back and WATCH them because I was giving neb treatments.

After first rounds, I texted my teacher. Here is our texting conversation:
Me: Can I do bipap as a student?!
Teacher: Yes you can.
Me: They arent letting me do anything but nebs only
Teacher: You can do bipap and you need to be in the ICU with vent patients. I will talk to the director and tell them what you are allowed to do but just make the most of the day
Me: OK

In my opinion he should have picked up the phone, called the department and just said hey, you know, my students need to be in icu. It would have taken 2 minutes. But anway....

I have always been told that clinicals are like job interviews. When you are at clinicals you are being evaluated by other RTs and by the director to see if you would be a good candidate for working there after school. BUT this works both ways. Students are also evaluating the hospitals to see if we would want to work there, in that environment, with those people...... I can guarantee you there is not a shortage of hospitals looking to hire RTs. And I can also guarantee you I will not work for a hospital that treats their students as work horses or as free labor. What does that make us think? It sure doesnt make me want to get hired on to find out anything else.