Wanted

Wanted:  PICU APN

                            Description: 5'2'', blonde hair, blue eyes

                                                                Last seen: Running around the crazy labyrinth also known as the                                                

                                                         PICU, then on to Rochester, MN for a few day Critical Care conference

                                                  Most likely to be:  completely hiding out at home, in bed

Oh yes...the last few weeks have certainly been crazy.

Just when I thought the PICU was going to have a bit of a lull, it completely picked back up and caught us by surprise.

We not only had a ton of kids come in, but we had a ton of sick kids!

And then on top of putting in a bunch of hours, I thought it would be a great idea to go to the exciting city of Rochester, MN (sorry for any of you living there!) for a Critical Care conference.

While the conference was a great learning experience, it was very different than what I expected.  Namely, I thought since it was an SCCM (Society of Critical Care Medicine) conference, it would have tons of people there.

But "tons" translated into exactly 16.  Yes, a very large, very full 16 new APNs, PAs, residents and fellows.

I will probably write a post about this soon, because it was a great learning experience, but I'm gonna end the post here...I'm not ready to be "found" just yet!

So I'm going back to my comfy bed, in my comfy pants, and watching some football with the windows open to let in the crisp fall breeze and the warm sunshine in, until I must be "Found" tomorrow at work.

Flying Solo

Well, I did it...

I made it through the first two days on my own as a PICU APN!

My preceptors thought I was ready to fly solo, so after being away from the PICU for 3 weeks, I came Thursday and yesterday not as an orientee, but as a full-fledged PICU APN.

I think I've said multiple times now that I'm an "official APN" like when I passed boards and became certified...when I was hired...when I started, etc.

But really, NOW I feel like it's official!

And last night after my second shift was done, Jon asked how it all went.

My response was "Well, I didn't kill anyone, so it was a great 2 days!"

To which he responded "Baaaabe, don't say that! That's horrible!"

I just laughed.  Because really, if you're in healthcare this is something that is said ALL the time.

Case in point: Yesterday a co-worker was asking how my first day on my own was and I simply said "good".  She laughed and said, "Yeah, well no one died yesterday, so it must have been good!"

See, it's just not me who's into the whole morbid PICU humor!

I must say I lucked out for my first 2 shifts. When I left the PICU 3 weeks ago, we were maxed out with patients at 14 (when we usually only take 12 because there are only 2 providers on each day), and on top of having a lot of patients, many of them were really sick!

But this week, things have slowed down a bit.  Our team had 9 patients, and not too many were extremely sick.  So that helped me out a lot!

And I'm hoping that the" slowness" carries on through the weekend because I'll be spending 24 lovely hours there this weekend.  And actually I'm insisting on slowness because tomorrow I will be the only APN working with one fellow, and Sunday I am the only APN with NO fellow!

Hello! That doesn't seem ideal!

But it's where I'm at.  So here's to hoping that flying solo throughout this weekend will result in soaring, and not crashing into windows!

                 source                                                                                                          source

So fresh and so clean, clean

Got that song stuck in your head now, don't ya!?

This post actually has nothing to do with the PICU. It has nothing to do with anything APN related either!

But every once and awhile, this PICU APN needs a break!  *No, I'm not forgetting the fact that we just got back from vacation about a week ago!*

And I'd say that's where today's post comes in.

Today's thoughts are about something deep.  Something you may need time to ponder.

It's about deodorant.

Yes, you heard that right...deodorant!

I don't have a deodorant brand preference.  I usually just buy what's on sale, or what's "free" with my CVS extra bucks.

But I noticed the other day when I was putting a few brands away after a little deodorant shopping spree (oh, no one else does that!?) that the labels are a little ridiculous!

For instance, why in the world would anyone need 48 or 72 hour protection!??!??!?

Are people really only putting deodorant on every other day?

I would think that a good 24 hours...or even 18 hours would do the trick!  If you can provide adequate smellage (yes, that's a word!) coverage while I'm working long shifts, than that's a winner in my book.

But does buying a deodorant that provides 72 hours of coverage really make it that much better?? I'm not sure.  I guess I've never paid attention.

So next few weeks when I'm working 10, 12 and 16 hour shifts, I guess I'll find out!

Until then, I'm going to let you ponder it over.  Deep, I know!  That's about as good as it gets on a Tuesday folks!

What Success Feels Like

In my last post (here), I talked about how incredible successfully intubating a patient was.  Except that I was only basing that on things that people told me.  I had actually never done it before.

And to be quite honest, it was the one thing, the one procedure, that was expected of me in the PICU that scared me.  A lot.  Or maybe downright terrified me!  

Either way, I hadn't done it, and  had never really been taught(at least on a human...mannequins don't count!).  And so part of the terror may be the unknown.  That, and the fact that it may be the one life saving measure for kids in the PICU that I had NO clue how to do!

Until today!  

That's right.  I successfully put in an ETT all by myself.  I'm a grown up APN now : )

I had an 18 month old patient that we were just expecting to put an LMA in.  But then the surgeon changed his mind at the last minute on how he wanted him to be positioned on the table, and we decided (ok, really the anesthesiologist decided because I don't know what the best airway in the OR based on positioning is!) to intubate.

I didn't even have time to think about it or get nervous.  Which was actually probably the best thing possible.

The attending anesthesiologist and the resident were hovering over each of my shoulders.  Normally this would make me start sweating profusely, but I actually was relieved that they were able to see exactly what I was seeing.

No more episodes like the other day when I'm saying the airway is super small, and the attending is saying "Uh, yeah kids airways are small!" without actually seeing what I'm seeing!

I must say, I stayed cool, calm and collected...MUCH more so than I would have been had I had to "prepare" for it prior to the case starting.

And I just slid that ETT in easily.  I saw the cords, and saw the ETT glide right through them.

It was such an incredible feeling.  Exciting. Exhilarating. Nerve-racking. Proud. Amazing!  

I did it! 

I conquered probably what was my biggest fear in the PICU.  And on an 18 month old, with a "very small airway!" 

So I learned a few important lessons today on success:

1.) Success is so much better after an initial failure

2.) Success is so much sweeter when it is a success at conquering a fear

3.)  Success is so much more special when it can be shared with others...who can praise you and gush over how well you did!

OK so the last one is a little bit of a joke, but let me tell ya it made my success so much better hearing the compliments and praise from both the attending and senior resident anesthesiologist!  The attending even said, "Wow that was great technique! Much better than many first year residents who have done this a bunch of times already!"

Bo-Yah!  

So there are my thoughts on success...and my success story!  I know down the road I may read this post and think," Wow, I've intubated a good 1000 times now, and could do it with my eyes closed...that's so cute that it was such a huge success back then!"

But until I get to that point, I'm going to savor the success after a failure, the success of conquering a fear, and I will most definitely savor the praise and gushing over that success!

APN in the OR!

Yes, I've been MIA.

But I've had a good excuse.  I'll give you one guess...

Yup, you probably guessed right! Jon and I went on vacation!

Well, it was a combo vacation and work conference for Jon, but it was full on vacation for me.

It was great!  It was 11 days full of nothing PICU related, no stress of trying to keep a little kid alive, and not overwhelming my brain with ridiculous amounts of new medical information.

But now I'm back to the real work.  Except, not my true real world.  I'm in the OR all week working with anesthesia.

That's right, an entire week of bag/masking, putting in LMAs, and intubating.

Let me tell you...there was about a half second that I thought about going to school to be a CRNA as opposed to an acute care nurse practitioner, and I'm SOOO glad that thought dissipated after the half second.

While successfully intubating a patient is an incredible feeling (or so I'm told because I haven't done it yet...I'll get to that!), doing that and giving gas/anesthesia to sleeping kids with very little interaction with the patient or family is SO not up my alley.

I love the PICU because I get to know my patients so well.  I get to form relationships with them and their families.  And that is so rewarding.

Nobody really leaves the hospital and profusely thanks their anesthesiologist...but they certainly leave thanking their PICU nurses and nurse practitioners.  That is not to say that their job isn't important (it's crucial to staying alive and asleep during surgical procedures!) but it's just very different.

So now that I've re-established my love for the PICU, let's get back to the successful intubation scenario.

I've spent the last 2 days in a satellite hospital OR which is super tiny.  There are 3 OR rooms- only 2 were being used yesterday, 1 today.  That means there are few cases each day.

And it means that it is all outpatient cases which tend to be "quick and easy."  So most kids don't get intubated.  A majority of mine yesterday got general anesthesia and just required a little bit of bag-masking, or even a nasal cannula.

I was able to place about 5 LMAs though which was good experience, and makes me feel more comfortable when I'm on nights in the PICU and more alone...if a patient is a difficult intubation I know that I can place an LMA!

So there was one patient today that could have had the procedure done with an LMA, but the anesthesiologist decided to fully intubate her for two reasons: 1.) so that I could have the practice, and 2.) because there is a propofol shortage and that's the medicine that he would have used if she wasn't being intubated.

So I got the chance to try to intubate her.  I had good technique with laryngoscopy and was able to visualize the vocal cords, but was unable to pass the tube.  The anesthesiologist asked if the vocal cords were open, and while I had a great view, I told him yes, but it looked really small.

He told me that the airway is small, so it wasn't going to be big, and try again. *Thanks, I know kids airways are small*

So I did try again, and once again could not pass the tube.

The anesthesiologist decided to attempt, and he said- "Ohhh...that's why...she's not fully muscle relaxed so her vocal cords are too compressed."  YUP- that's what I said...her opening was very small! So he muscle relaxed her, her vocal cords widened, and he easily passed the tube.

So I was frustrated at myself for not being able to get it...and then felt a whole lot better that there was an anatomical reason for why I was unsuccessful.  I was also really glad to have this experience in the OR, where it is an extremely controlled setting, there are no parents freaking out, and it is super quiet!

I have 2 more days in the OR this week, and I'm hoping to get a few more intubation opportunities tomorrow.  With only about 7 cases that may be unlikely, but we'll see.

So until this weekend, you can call me pseudo-OR-APN!  But I'll always be a PICU APN at heart!