PICU help

[adpimango]

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Mmmkay, so I start my pediatric ICU month here in like 4 days and I'm freaking out. I've already had my pediatric clerkship, but it was like september/october 2006 (so what like almost 6 months ago?) and ive been doing freaking medicine since! I figured that jumping right into ICU would be a good idea cuz I would learn a lot...we'll see how that goes... basically I was wondering if anyone had any advice as to how to prepare for the rotation, how to do well on the rotation, and what resources if any are a must have to survive it... i know i can rise to the challenge i just wanna limit my inevitable rape-age to a minimum if possible.

 

[pjl]

Remember, kids are just little adults. So give them the same stuff just less.

 

[Winged Scapula]

"Don't touch the babies!!!!"

Sorry, that was NICU! 😀

First, find out if the PICU is a closed unit (ie, the PICU is primary service or consult for the patients) or whether or not other teams admit (ie, Trauma, Peds, Peds Surg, Neurosurg, etc.).

Then, like any other rotation, make sure you know where to be, how to get there and at what time on your first day. Ask if you should "just show up" on the first day, or are expected to pre-round on patients.

Kids in the PICU will have varying problems, of varying severity and be of varying ages. You can have a hulking 16 yo right next to the 6 mo baby. Some will be intubated, some have feeding tubes, some will require frequent neuro checks, etc. Like any ICU.

There are handbooks and other Peds books, but the gold standard is the Harriet Lane handbook. Might be overkill if you aren't going into Peds, but you can get used copies on Amazon pretty cheap, or borrow it from the library. Pretty comprehensive. Also consider a PALS/Pediatric Lifesaving card for your pocket as well as a drug handbook, like Tarason's, which has Pediatric dosing.

Be able to calculate appropriate IV fluids and rates. Make sure to report urine output in cc/hr rather than by shift. Know what the kids are being fed (ie, tube feeds) or are eating. Drain(s) (if any) output...standard ICU stuff.

With regards to the first above, if there are several teams involved, it is helpful to know the plan from them - ie, if a Pediatric trauma, Ortho, Neurosurg and Peds Surg may all be involved. Check with them to see what their plans are.

Is family around? If a trauma, is non-accidental injury suspected? If so, what is social work's/CPS's input? What have the various tests and consultants said?

Oh yeah, and don't touch the babies.!

 

[dentate_gyrus]

Kids in the PICU will have varying problems, of varying severity and be of varying ages. You can have a hulking 16 yo right next to the 6 mo baby.
Be able to calculate appropriate IV fluids and rates. Make sure to report urine output in cc/hr rather than by shift.

report fluids in cc/Kg/hr, I got dinged on that one.

 

[oldbearprofessor]

"Don't touch the babies!!!!"

Sorry, that was NICU! 😀


Oh yeah, and don't touch the babies.!

Still having flash-backs on that one, heh?😛

You can touch the babies, just ask the nurse's permission first. 😀

and don't WAKE the baby to do your exam (unless it's an emergency, and if it's an emergency, the baby isn't sleeping) and "finders, changers" if you know what I smell, er, mean.....

 

[Winged Scapula]

report fluids in cc/Kg/hr, I got dinged on that one.

D'oh! Yeah...that was what I MEANT. 😀

 

[Winged Scapula]

Still having flash-backs on that one, heh?😛

You can touch the babies, just ask the nurse's permission first. 😀

and don't WAKE the baby to do your exam (unless it's an emergency, and if it's an emergency, the baby isn't sleeping) and "finders, changers" if you know what I smell, er, mean.....

A little PTSD, me thinks.

I am SURE the NICU nurses would rewrap the baby-burritos at 5:25 am just in time for 5:30am rounds, so that they could yell at us as we walked onto the unit.

 

[oldbearprofessor]

A little PTSD, me thinks.

I am SURE the NICU nurses would rewrap the baby-burritos at 5:25 am just in time for 5:30am rounds, so that they could yell at us as we walked onto the unit.

Well, if you really want to understand the usual dynamic (I'm not defending, I'm explaining....) what happens is that the night shift nurses will train the pedi residents the first night as to what time they feed the babies for their 6 AM feeding. The residents know to zip by and do their AM physicals then. Since the nurses can make their lives H$#$, this system usually gets in place very rapidly.

Consulting services don't connect to this system as well and often miss just the right minute that they are allotted to examine the baby. So, after they wake the baby to spend 5 seconds feeling his belly and saying "doing good, we can keep advancing feeds" the nurse is left with a crying baby who has already eaten, etc. This leads to yelling at 5:30 AM.

That part I'm sure you understand (but others reading this might not). Then, the part you may not realize is that they come and complain about the consult services to the attending neonatologists. Well, you can guess that none of this makes for happiness in the NICU and the end result is that the relatively innocent consult services, just doing their job, get dumped on by the nurses and everyone else....ultimately policies are put into place that say that the babies cannot be examined except at set times unless in an emergency.

Making this work for everyone is possible with a bit of communication and mutual understanding, and in recent years we've tried to do it, and mostly things are better than even a few years ago in many centers. Occasionally, a consulting service will feel that they don't want to go along with what we've worked out to let the baby sleep (truly a key for neurodevelopment) and wake the baby to get their physicals done. They earn nursing wrath and a "reputation" and lately, a call to their chief.

A lot of these issues are just being dealt with "forthrightly" now in many NICUs (and also in other areas of a hospital where there are babies and small children) and of course, in some cases it has gone better than others.