NICU 101

Baby born without butthole = not good.

Dear CRNA

Pitocin is not epidural.

Epidural is not Pitocin.

Good luck with that lawsuit.

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.
************
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!