clinical stories
Since I don't go anywhere except work and school, the only thing I have to write about are more clinical stories. So here goes...
Last week was the end of my pediatrics rotation. I spent the day in the PICU which is always interesting. To clinch the interesting cases, I observed what happens when the hospital loses power. As you can imagine, kids in the PICU are hooked up to all kinds of machines, including ventilators for the majority of them. So no power equals no air for these kids. I have never seen people move so fast in my life. Before I could blink twice, those nurses were all over those kids, hooking them up with air via ambu bags. The back up power kicked in within 15 to 20 seconds, but the intensity level didn't drop for several minutes. One of the vents malfunctioned so they had to go on battery power for that child. But the kids never even noticed anything had happened, so everything was good.
At the end of the day, I headed down to the floor for our post-conference. Since the rest of the students were all busy finishing up their patient charting, I just hung around. Then one of the students told me that the nurse he was with had a patient who was going to have a central line taken out, and I could watch if I wanted to. Fantastic! Turns out the kid was one that had been in PICU the first time I was up there.
So I headed in to watch the doctor procede take out this line. He made an incision to open the hole where the tube entered the center of his chest. The line had been in so long that the flesh had grown around it so he had to keep cutting and cutting. One of the most pathetic things I've seen in my peds rotation is these kids on vents who cry but can't make a sound. He was flailing, and I'm sure if he could have made a sound, there would have been a tremendous wailing. Finally after what seemed like an hour but was probably only 15 minutes, he got the line out. Then he ordered an x-ray to make sure nothing was left behind before he sutured the hole shut.
After the x-ray, which caused the kid great distress, he suddenly clamped down on his trach and started to lose his oxygen saturation. So the nurse hyper-extended his neck to open his airway. The trach fell out leaving him with no airway at all. Neither the doctor nor the nurse could get it back in and his oxygen level continued to fall. I was calling out O2 sats and heart rates as they continued to work on him. It got down to 27% O2 sat and 68 beats/min. So the nurse yelled at me to go call a code. So I did. The people at the nurses station just stared at me for what seemed like an eternity, so I yelled it again. Within a very short amount of time, they had the crash cart in there and the room was swarming with doctors and nurses. One of the nurses was asking, "Is this real?" as she came through the door. Then, of course, I had to leave because I was no longer necessary and there were too many people in the room. I did hear that he survived.
Today was the first day of my last rotation for this semester. I was assigned to go to children's surgery. I got to watch some tubes inserted in ears and adnoids and tonsils removed. The doctor was so cool! When he found out I was a student there to observe, he just went into teaching mode. He let me come look into the scope during the surgery. That was just the coolest thing ever!
I also got to watch a gall bladder being removed. It amazes me that they ever figured out how to recognize one organ from the other. I can usually recognize the liver, no problem; but that other stuff all looks the same to me.
One last experience....my last day in the PACU (children's recovery room), we had a 13-year-old kid come in after an endoscopy. This was no puny kid. As he was coming out of his sedation, he became very combative. He wanted to get up out of his bed and walk out of there, which was not a possibility. We couldn't get that through his head. He said he HAD to get out of there before it was too late. We tried to get him to tell us why it would be too late and where he wanted to go. Three of us were having to hold him down during all this. Even then, he'd quite literally sit up anyway, practically lifting us up. We were understaffed because it was lunch time and 2 of the nurses had gone to get food. So it was only 2 nurses and 2 students in there and the other nurse had a patient she couldn't leave. So I basically laid on the kid's one shoulder, while the nurse laid on the other one and the other student ran to get help. One of the anesthesia guys came and leaned on his chest. The father finally came in there and managed to calm him somewhat, but even he couldn't talk him out of his mania. His eyes were just wild-looking. The father told us later that the kid's uncle had died in the hospital recently. It made a lot more sense then.
Enough stories for now.
Last week was the end of my pediatrics rotation. I spent the day in the PICU which is always interesting. To clinch the interesting cases, I observed what happens when the hospital loses power. As you can imagine, kids in the PICU are hooked up to all kinds of machines, including ventilators for the majority of them. So no power equals no air for these kids. I have never seen people move so fast in my life. Before I could blink twice, those nurses were all over those kids, hooking them up with air via ambu bags. The back up power kicked in within 15 to 20 seconds, but the intensity level didn't drop for several minutes. One of the vents malfunctioned so they had to go on battery power for that child. But the kids never even noticed anything had happened, so everything was good.
At the end of the day, I headed down to the floor for our post-conference. Since the rest of the students were all busy finishing up their patient charting, I just hung around. Then one of the students told me that the nurse he was with had a patient who was going to have a central line taken out, and I could watch if I wanted to. Fantastic! Turns out the kid was one that had been in PICU the first time I was up there.
So I headed in to watch the doctor procede take out this line. He made an incision to open the hole where the tube entered the center of his chest. The line had been in so long that the flesh had grown around it so he had to keep cutting and cutting. One of the most pathetic things I've seen in my peds rotation is these kids on vents who cry but can't make a sound. He was flailing, and I'm sure if he could have made a sound, there would have been a tremendous wailing. Finally after what seemed like an hour but was probably only 15 minutes, he got the line out. Then he ordered an x-ray to make sure nothing was left behind before he sutured the hole shut.
After the x-ray, which caused the kid great distress, he suddenly clamped down on his trach and started to lose his oxygen saturation. So the nurse hyper-extended his neck to open his airway. The trach fell out leaving him with no airway at all. Neither the doctor nor the nurse could get it back in and his oxygen level continued to fall. I was calling out O2 sats and heart rates as they continued to work on him. It got down to 27% O2 sat and 68 beats/min. So the nurse yelled at me to go call a code. So I did. The people at the nurses station just stared at me for what seemed like an eternity, so I yelled it again. Within a very short amount of time, they had the crash cart in there and the room was swarming with doctors and nurses. One of the nurses was asking, "Is this real?" as she came through the door. Then, of course, I had to leave because I was no longer necessary and there were too many people in the room. I did hear that he survived.
Today was the first day of my last rotation for this semester. I was assigned to go to children's surgery. I got to watch some tubes inserted in ears and adnoids and tonsils removed. The doctor was so cool! When he found out I was a student there to observe, he just went into teaching mode. He let me come look into the scope during the surgery. That was just the coolest thing ever!
I also got to watch a gall bladder being removed. It amazes me that they ever figured out how to recognize one organ from the other. I can usually recognize the liver, no problem; but that other stuff all looks the same to me.
One last experience....my last day in the PACU (children's recovery room), we had a 13-year-old kid come in after an endoscopy. This was no puny kid. As he was coming out of his sedation, he became very combative. He wanted to get up out of his bed and walk out of there, which was not a possibility. We couldn't get that through his head. He said he HAD to get out of there before it was too late. We tried to get him to tell us why it would be too late and where he wanted to go. Three of us were having to hold him down during all this. Even then, he'd quite literally sit up anyway, practically lifting us up. We were understaffed because it was lunch time and 2 of the nurses had gone to get food. So it was only 2 nurses and 2 students in there and the other nurse had a patient she couldn't leave. So I basically laid on the kid's one shoulder, while the nurse laid on the other one and the other student ran to get help. One of the anesthesia guys came and leaned on his chest. The father finally came in there and managed to calm him somewhat, but even he couldn't talk him out of his mania. His eyes were just wild-looking. The father told us later that the kid's uncle had died in the hospital recently. It made a lot more sense then.
Enough stories for now.
posted by Sara | 1:55 PM
1 Comments:
You definitely have some interesting stories to tell. I stumbled across your blog by looking at comments posted on my cousin, Dr. Hans Burkholder the Mad Hatter's blog, and after reading some of your posts felt inclined to reply. I presumed from your method of finding the Mad Hatter's blog that it would be OK if I posted something here on your blog.
It seems that Mennonites are a bit of an anomaly in the medical field these days, aren't they. I had to laugh when I was once called a "young Amish man" by one of my well-meaning fellow students early last school year. I'm still in stitches.
Yes, I am a student, a sophomore in a BSN program at Alvernia College in Reading, PA, and looking forward to clinical rotations next semester. Check out www.alvernia.edu
Your stories about clinical experiences are interesting and in a way help to give me a little bit of incentive to keep studying. It is good to hear about some real life experiences instead of just reading text books and practicing on mannequins.
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