I spent the whole week in the PICU.
I did a large teaching session with the nurses on head trauma/ brain tumors/ and anatomy of the brain. How to treat and recognize signs of increased ICP, Cushing's Triad, etc... and how to intervene. How to recognize subtle changes and how to treat.
The hospital got a new feeding pump, so I spent some time showing the nurses and the nursing educator how to use this machine so that a family can take it home and provide G-tube feeds with this new pump.
What I rec'd as teaching- Learning how to use a ventilator and getting support from the nurses. Which was a great two-way street.
Primary patient that I cared for started on Day 1 when this 10 yo malnourished child was transferred from another hospital and quickly sent to PICU. After a CT scan- quickly discovered a tumor in the cerebellum likely medulloblastoma. Cared for this child until he started to quickly de-compensate and was able with Jen's (charge nurse) help to advocate for this child to get his shunt asap.
Other patients I assisted with
a. 7yo boy with gun shot to the head. Assisted with dressing changes, meds, management of airway.
b. 28 day-old baby- difficult labor- mom died in childbirth and baby was basically dead but being kept alive. Dad was having trouble letting go. He extubated him on the last day of our trip.
c. 16 month-old with hx of imperforate anus and reversed colostomy. Patient was completely lethargic and vomiting stool, required transfusions, a lot of suction, intubated and severely malnourished. Helped with constant suction with syringes only to get rid of all the stool, management of airway and just trying to keep this very sick child stable.
A lot of what I did was working alongside the peds residents, making suggestions and asking if certain elements of management were possible, to try and "gently" push the care forward and to support their learning. When possible I would take on a case myself to help get the child in and out as efficiently as possible to relieve the work load and be able to reduce the cost for the patient by providing the necessary supplies.
Respiratory illnesses were the majority of the cases in the ED. There was about a dozen children that came through aged 2 months to 12 years who required IV antibiotics, nebulizers with albuterol and iv fluids. For the most part these kiddos stayed in the ED until they were stepped down to oral antibiotics. Two of the infants had to be admitted to the peds unit for continuation of iv antibiotics.
One 5 year old boy in particular was having a lot of difficulty breathing with minimal air entry and dropping oxygen saturations, he was riding the fine line of respiratory failure on his first day in the ED - he turned around and by our last day he was grinning ear to ear and giving me hugs :)
I worked with the residents to create the management plans for these children and did a lot of the monitoring and physical exams and would push for more intervention for the kiddos that were really struggling and needed their care to be escalated.
There was a child with a seizure disorder (to be confirmed) who was continually seizing. Again I worked with the residents to create his management plan -- starting phenobarbital and trying to expedite an appointment with a neurologist at another hospital for assessment/EEG. We also discussed his care with his parents (what to do when he's seizing) and tried to support them to feel comfortable enough to take him home.
There were also some minor lacerations that I sutured. Skin infections that I cleaned up and provided antibiotics for.
We also had the boy with the brain tumour come through the ED, that Virginia ended up looking after. When he came in I worked closely with the first year resident (it was his 2nd day there) helping guide his exam -- teaching him how to check for ICP. We then went through the differential diagnosis and based on this did an appropriate work up on the child --- basically our process was when reviewing a consult, I walked through with the resident to ensure we were being thorough and wouldn't miss something.
Participated in the rounds of the children in the PICU, trying to provide suggestions to help expedite care. The children there that we helped with included an infant with an anoxic brain injury, our boy with the brain tumour, a gunshot wound to the head, a toddler post colostomy reversal that then had an obstruction and was vomitting up stool/suffered from malnourishment, and a neonate with hirschsprungs. Unfortunately the prognosis of survival for these children is quite grim.
The new born who suffered an anoxic brain injury during birth (mom passed away) -- Towards the end of the week the dad had agreed to extubation and to a DNR. We reviewed this case several times with the residents to help make suggestions to appropriately palliate this child...including taking him off the epinephrine infusion, fluid and feed management and pain management. This kiddo was still hanging on the morning we left but from what I saw on his monitor he wasn't to last beyond that day...I was pleasantly surprised to see his dad at bedside stroking his head ---- it was so nice to know he wasn’t alone in his final moments (as you know that was my thorn that breaks my heart).
The toddler with the bowel obstruction had a history of an imperforate anus, had a colostomy which was reversed one month ago - he had been transferred from another hospital. He did start to have emesis that was all stool. And he was severely malnourished. I really pushed for imaging to happen asap and we had to wheel him across the compound with Virginia carrying the monitor and me bagging him to the x-ray and back. We then pushed the pediatric team to have their general surgeon see --- it sounded like at the end of the day they were hoping he would go to the OR the following day.
We also were able to provide day to day supplies (diapers, clothing, tooth brushes and NG feeds) to the families that were in the peds ED, PICU and peds inpatient from donations that we received.
And then in the OR I assisted Michel with the removal of an infant's extra digits/separating webbed fingers, placing a skin graft to a child whose head had been severely burned, and the repair of a young adult’s fractured metacarpal.