Things I have learned by mistake
Most of my experience is in a NICU, so of course, I haved screw up on the most critical of patients.
On my first NICU transport as the lone RT, I was scared to death. My coworkers made me go because, "you need the experience." Thanks. I had a fellow and a very experienced nurse with me, so what could go wrong, right?!?! I told them that I was scared and didn't want to go and was reassurred that I would be fine. They talked me down and reminded me that my job was the airway. Nothing more, just airway.
Ok, I can do this. I know how to bag, tape a tube, work the vent on the transporter. Just keep it simple. Airway. Plain and simple.
This is how it looks on the baby, so I had it set up exactly like this in the transporter. All we had to do was take the baby off the cpap in the isolete and put him in the transporter and put him on the new setup. Sounds simple, right?
Important part of the story. This baby is a twin and the mother is there watching our every move. The other baby was doing better and staying at the original hospital. We were taking the sicker baby.
Also on this baby is some duoderm underneath the nasal prongs to help prevent septal breakdown. The ones we used were t-shaped. This hospital used something like this, where holes for the nares had to be cut. No big deal.Okay, now to the good part. We put the baby in our transporter and the ambulance driver (who was in nursing school and always eager to help) was helping me attach the hat and the rubber bands. The pressure manometer was reading +5 and everything was going swell.
The nurse and I went back to the warmer and started collecting the baby's things. Then horror of horrors...I hear the nurse say,
'what the fuck?!?!'
I look at the baby in the transporter. Completely apenic and blue (closer to black is more like it). She rips the hat and prongs off the baby and starts bagging him.
This is the point where the mom started freaking out and crying.
We put the baby back on the warmer so we can figure out what happened. Wouldn't you know it, the freakin duoderm had moved position and was occluding one of his nares. Problem solved, however at this point I was so frazzled and embarrassed I couldn't stop my hands from trembling. The attending decided to just intubate, since we were going to do that when we got home anyways.
I was so discombobulated, I was having trouble getting my head together.
Get it together. You have a job to do. Suck it up. Set up to intubate, you know what to do. Get it together. Baby is okay, do your job. Idiot...patent nares are important. I knew I shouldn't have come on this transport. Wake up, this is just a bad dream. Isn't the rapture supposed to happen NOW!! Snap out of it, you have a job to do!!!
I couldn't get it together. Thank God the RT was there from that hospital. He jumped right in and took over for me without making me look like the worthless, green, retarded RT that I was.
They were intubating and I was working on cutting the tape for the ETT. My hands were shaking so bad and my confidence was nothing, I couldn't see straight. Of course there was an audience in this 30+ bed NICU. I just wanted to die. One of the nurses who was watching me have a complete meltdown came and whispered in my ear,
"you are doing fine. relax & take a deep breath."
The voice of an angel. After that, I was better, well sort of. I got it together enough to tape the tube (while constantly thanking the rt), set up the vent on the transporter and get the hell outta there.
So here is # 2 on my list of what I have learned by mistake....
MAKE SURE THE NARES ARE PATENT!!!!
That was my first big f-up, so after that, my job was cake. I could handle anything. I have never had a meltdown like that again. But just telling the story causes my bp/hr/rr to increase. I just can't explain how horrible it was.
Another thing I never got the chance to do....
THANK YOU to the RN (I never caught your name) and to RT F for saving my ass!!!!
THANK YOU to the attending and RN on the transport team for being so great and not ripping me a new one!!!
