How Many RTs Does It Take?
I am happy to say that I have five days off. They are so earned after last night.
I'm pretty sure that we may have had the craziest night I have ever seen. We had seven RTs in NICU, and we could tell at shift change that it wouldn't be enough. Now that's when you know its going to be crazy! We started a jet at shift change and then started another 45 minutes later in the same room. There were then mass retapings, occupying all but two of us. Did I mention they sent us another person? Thank heavens because we needed her more than we knew.
Nothing wanted to work right, vents alarming and babies bradying left and right. We were running. Even our "dirty" RT who only had our isolation baby worked her tail off. She ended up adding a continuous neb and Q4 CPT to the mix, making her one baby a full (and busy) assignment in itself.
I got a little one from an outlying hospital with "TTN" that they had bagged the whole way to us. He crumped in the elevator to the ambulance and they were unable to get him intubated. We immediately intubated him and started him on conventional vent. During that, they wanted continuous nebs on my other child.
When I went to give surfactant, I turned around to get my assistant. By the time I turned my head back around to my patient, his sats and BP were starting to bottom out. The nurse started pushing fluid fast and we ran for the nitric. More fluid and more fluid and soon we were running for the oscillator too. The first one (which had checked out just fine) wouldn't pressure up for anything. We furiously checked for leaks, changed caps and still nothing.
Our clinical specialist (in a beautiful Hail Mary play) went for the last one we had ... but no circuits. She ran down and then up four flights of stairs to grab more and was so out of breath that she couldn't even punch the code in to get the door to our equipment room open. I think she could have qualified for the Olympic trials at the pace she was running.
They got it checked out in record time and he was oscillating with nitric. Finally, our baby was a little happier, but he still bought himself 20 of dopamine with dobutamine on standby. All of my suspicions that he was PPHN had been confirmed. Our blood gas was not pretty and put the ECMO team on alert. We upped his settings and more fluid. Our next gas drew a crowd in anticipation ... and dread. I was ready to calculate my oxygen index.
Hallelujah! Our values had stabilized and we were in the clear with a PO2 of 203. One more retaping, a round of chest X-rays and it was time to give report. That was one of the fastest nights I have ever had.
I truly have to say that I have some of the most amazing co-workers. They banded together in a way that was stunning. We worked together like a single unit. I even had a nurse pull me aside to tell me that she was amazed how RTs worked so well as a team. She had never seen anything like it.
To be honest, neither had I. We are a pretty strong team, but last night was raising the bar to the stratosphere. I am so proud and so thrilled to be part of something that was simply amazing. How lucky are we to get the opportunity every day to be something special? We are in such a dynamic and awe-inspiring profession that I thank my lucky stars that I ended up as an RT. It's just incredible to be able to have nights like that.
Here is my call to every RT out there: Give yourself a pat on the back. You are an expert. You change lives every day you put on your scrubs and go to work. You are the first two items in the ABCs. The next time you have a wild night (or day) at work, just think about how amazing it is to do what we do. I'm proud of all of you!
--Stephanie