"We need a team for a csection with anomalies."
That was all we were told. Since I was the new girl, I went to
everything. I needed the experience my coworkers said.
Normally, this would be handled by an rn/rt. Since the word 'anomaly'
was thrown in, we grabbed the fellow to come with us.
The csection was taking forever, so we were just yaking, expecting a
term baby with an extra/missing limb. No big deal. I took the scapel
off the crash cart & used it to cut some tape so it would be ready for
the next baby that was intubated.
The fellow brings the baby to the warmer & there is absolutely NO
respiratory effort. The rn listens & the heart rate is 40. The mood
quickly shifts & we start working. I started bagging, the rn is
listening saying that she can't hear any breath sounds. There is also
no chest rise on this blue baby, so I readjust the mask, get a better
seal & try again. Still nothing. No resp effort, hr <60, blue, limp,
nothing.
Now panic mode sets in. The fellow takes the bag/mask from me &
attempts to ventilate the baby himself. Still nothing, no chest rise,
no breath sounds...nothing.
About 2 minutes have passed & the fellow decides to intubate. He is a
very good intubater so I was glad we brought him. I hand him the tube
and he tells us, "I can see cords, but I can't get it in." So I grab a
smaller tube & the same thing. He can't get it.
This is when the oh shit mode kicked in.
He yelled to have someone call for the attending to come down. The
baby is still just there, no nothing. At some point, compression were
started, we tried to ventilate, still with no chest rise or breath
sounds.
The attending tried, the anesethiologist tried. Everyone could see the
cords, but they couldn't pass the tube through them.
What the f is going on?
Oh yeah, the dad is watching over our shoulder the entire time as we
are pretty much communicating with our eyes & underneath our breath.
So we askef one of the labor nurses to get him out of the room.
ENT was paged stat. We called for another rn/rt team. We needed some
help BIG TIME!!!
We were way beyond oh shit mode. Now it was every-explicitive-in-the-
book mode. It had been at least half an hour. WAY TOO LONG. Still we
had no airway & a heart rate <60.
3 ENTrs come in along wirh another nicu nurse & rt. So that makes 10
people working on one baby on a little tiny warmer.
They decide they are going to trach the baby. "where is a scalpel?"
one of the doctors ask.
Oh shit!!!!!!! I used it to cut stupid tape & now it's dirty.
Shit!!!!!!! He didn't care, the baby needed an airway yesterday, so I
wiped it off with alcohol & handed it to him.
He dissected the neck and guess what? Nothing. There was no where to
put a trach. There was only an esophagus. No trachea. Nothing below
the cords. Everyone was stunned.
So now what? It had been 45 minutes of anoxia & you can't live without
an airway, so we stopped. Everyone left except me & the original
nurse. There were sharps & blood everywhere. We cleaned up the mess &
started working on cleaning up this poor little baby.
We cleaned the blood off the baby & taped a 2x2 over his neck. We
swaddled him up & the nurse turned around to show him to his mom, who
was still there, on the table.
The worst part of this whole episode was the mother's first words. I
can still vividly hear her say,
"¿Esta bien?"
Now I don't know a whole lot of Spanish, but I know enought to know
that she had absolutely no idea what had just happened. The nurse
looked at me like, help me, what do I do now?
Thank God, the ob was there and she jumped in & started talking to the
mom in Spanish.
That is the day I decided I both hated & loved the NICU.
That was all we were told. Since I was the new girl, I went to
everything. I needed the experience my coworkers said.
Normally, this would be handled by an rn/rt. Since the word 'anomaly'
was thrown in, we grabbed the fellow to come with us.
The csection was taking forever, so we were just yaking, expecting a
term baby with an extra/missing limb. No big deal. I took the scapel
off the crash cart & used it to cut some tape so it would be ready for
the next baby that was intubated.
The fellow brings the baby to the warmer & there is absolutely NO
respiratory effort. The rn listens & the heart rate is 40. The mood
quickly shifts & we start working. I started bagging, the rn is
listening saying that she can't hear any breath sounds. There is also
no chest rise on this blue baby, so I readjust the mask, get a better
seal & try again. Still nothing. No resp effort, hr <60, blue, limp,
nothing.
Now panic mode sets in. The fellow takes the bag/mask from me &
attempts to ventilate the baby himself. Still nothing, no chest rise,
no breath sounds...nothing.
About 2 minutes have passed & the fellow decides to intubate. He is a
very good intubater so I was glad we brought him. I hand him the tube
and he tells us, "I can see cords, but I can't get it in." So I grab a
smaller tube & the same thing. He can't get it.
This is when the oh shit mode kicked in.
He yelled to have someone call for the attending to come down. The
baby is still just there, no nothing. At some point, compression were
started, we tried to ventilate, still with no chest rise or breath
sounds.
The attending tried, the anesethiologist tried. Everyone could see the
cords, but they couldn't pass the tube through them.
What the f is going on?
Oh yeah, the dad is watching over our shoulder the entire time as we
are pretty much communicating with our eyes & underneath our breath.
So we askef one of the labor nurses to get him out of the room.
ENT was paged stat. We called for another rn/rt team. We needed some
help BIG TIME!!!
We were way beyond oh shit mode. Now it was every-explicitive-in-the-
book mode. It had been at least half an hour. WAY TOO LONG. Still we
had no airway & a heart rate <60.
3 ENTrs come in along wirh another nicu nurse & rt. So that makes 10
people working on one baby on a little tiny warmer.
They decide they are going to trach the baby. "where is a scalpel?"
one of the doctors ask.
Oh shit!!!!!!! I used it to cut stupid tape & now it's dirty.
Shit!!!!!!! He didn't care, the baby needed an airway yesterday, so I
wiped it off with alcohol & handed it to him.
He dissected the neck and guess what? Nothing. There was no where to
put a trach. There was only an esophagus. No trachea. Nothing below
the cords. Everyone was stunned.
So now what? It had been 45 minutes of anoxia & you can't live without
an airway, so we stopped. Everyone left except me & the original
nurse. There were sharps & blood everywhere. We cleaned up the mess &
started working on cleaning up this poor little baby.
We cleaned the blood off the baby & taped a 2x2 over his neck. We
swaddled him up & the nurse turned around to show him to his mom, who
was still there, on the table.
The worst part of this whole episode was the mother's first words. I
can still vividly hear her say,
"¿Esta bien?"
Now I don't know a whole lot of Spanish, but I know enought to know
that she had absolutely no idea what had just happened. The nurse
looked at me like, help me, what do I do now?
Thank God, the ob was there and she jumped in & started talking to the
mom in Spanish.
That is the day I decided I both hated & loved the NICU.