I don’t think I’ve had that many procedures at the bedside in my 10 months in the Peds ICU… combined. But God was watching over me today, sending help when I need it.
Intubation, cardiocentesis, failed femoral line placement, IJ placement, desat and brady so bad that I had to hit the code button, travel to go stat CT, bilateral thoracentesis with chest tube placement, and significant hypotension because he’s pretty much going into septic shock. ALL IN ONE SHIFT.
Oh and back for more tomorrow night. Yay.
So I came in and my 6 month old patient with no past medical history is on Vapotherm, 15L 55% FiO2. Still tachypneic to 60-70’s and pretty significant work of breathing, with belly breathing, head bobbing, and subcostal retractions.
After rounds around 1000, we put him on 20L 50% on VT. The kid didn’t really improve. We did a chest x-ray and it showed pretty significant opacity around the heart. We did an echo and it showed a lot of fluid around the heart. And then we did an ultrasound with the cardiologist and confirmed the pericardial and pleural effusions. This kid is at a huge risk for obstructive shock – cardiac tamponade to be specific. So they decide to get he fluid out. At the bedside. Great. (Isn’t this what the OR is for?!)
Around 1100, we started to intubate. Pretty much went without a hitch. Took a long time to stabilize the tube, he desatted a few times but everything went ok. See, when intubation is the easiest part of your day, you know that’s a shit day.
Around 1300, we started to prep for the cardiocentesis. The cardiologist performed the tap and pulled lots of purulent fluid. Definitely something growing there.
At 1400, an attending and a fellow attempted to place a line in him. They tried to get a right femoral central line, but couldn’t do it. After an hour and a half, they gave up and settled for an IJ.
Around 1545, the respiratory therapist was rearranging the vent. Then my kid started desatting to high 80’s. So I started bagging. He came back up so everything was ok. And then he started to desat again. I bagged but he wasn’t coming up. Then he started to brady to 90’s. (He’s been sitting 110-140’s). That’s when I hit the code button, and of course everyone (and I mean everyone) rushed to my side. But then he started coming back up, we got good ETCO and good bilateral breath sounds. So at least I know he didn’t self-extubate. Because that happens to my kids. A lot. -_-
Around 1630, we headed down to stat head CT. That was one of the scariest things I’ve ever done. Trying to carry a baby from his crib to the CT bed with all his lines, pericardial drain, and his ET tube was not fun. But thankfully everything went ok.
We got back to the unit at 1700, and then immediately started to prep for bilateral thoracentesis and chest tube placement. An attending, a fellow, and a nurse practitioner all did the procedure and it went well.
Around 1830 though he started to be really hypotensive, more than he’s been all day. So we finally bolused him with albumin (after tons of NS boluses all day).
Aaaand before I realized it, it was 1900 and time to give report.
Yeah. That. Holy ajfniekjnfvzmd. I was shaking and tired and overwhelmed. But people were so great and helpful and thoughtful. I could not have survived without everyone’s help. The best part was that everyone was so understanding and was so encouraging. Just when I feel like I’m about to crash or get too overwhelmed, someone comes up to me and tells me I’m handling this incredibly, impossibly, unrealistically busy day well. And when I haven’t eaten, gone to the bathroom, or sat down in a very long time, and I want to scream and cry and go home, hearing encouraging words is really the only thing that keeps me together.
Today was hard, but that’s Pediatric ICU nursing for ya. God was definitely by my side all day today, and so were my amazing coworkers. I couldn’t be more thankful.