neonatal icu

anonymous asked:

Hiya, Aunty! Has anyone ever asked yet what the differences between each ICU type is because I still get confused by them

Hey nonny! No, this is the first time this question is coming up, which means that I get to go off about one of my favorite topics!

An ICU (Intensive Care Unit) is a special unit in a hospital for a patient who is “critically ill”. There are a lot of reasons people can be admitted to an ICU. (In the UK I believe these units are called ITUs, Intensive Therapy Units.)

ICUs are areas where extremely sick patients get closely observed. Where an ER or medical-floor nurse might have 6 or more patients to attend, an ICU nurse has just one or maybe 2. They’ll get more frequent visits from doctors, have their intakes and outputs (”Is and Os”) monitored, medications adjusted, very frequently. If they’re on a ventilator or respiratory support, they’ll be in the ICU. Serious chemical and salt imbalances or extremes of blood sugar, blood pressure, and organ function are seen in the ICUs.

There are loads of different types. Some small hospitals may have only one “catchall” ICU, for the “really-sick” patients. Some may have dozens; I work for a hospital system with a great many ICUs. Generally, patients are sorted based on what service they primarily need.

The Medical ICU (MICU) is where generically medically-sick patients go. Issues like sepsis are handled here, as might asthma patients, patients with acute abdomen, etc.

Though this gets tricky: some hospitals also have a Respiratory Care Unit (RCU).

Many post-operative surgical patients are discharged to a Surgical ICU (SICU)  from the OR. SICU can also hold patients pre-op for observation and testing.

One type of SICU is a Cardiothoracic ICU (CTICU). This is for patients who have had their chests opened during surgery for whatever reason, as the possibility of re-bleeds requiring immediate surgery is high and the consequences can be rapidly fatal.

Critically ill heart patients – including those who’ve recovered from cardiac arrest or suffered heart attacks with significant damage – are admitted to a Cardiac Care Unit (CCU).

Neuro ICU (NICU) and Neonatal ICU (NICU) (which is separate from a Pediatric ICU (PICU)) share the same abbreviation but drastically different populations; Neuro ICUs treat patients suffering from strokes or hemorrhages in the brain, while Neonatal ICUs treat critically ill newborns. Some hospitals will call their Neuro ICU a Neuroscience ICU (NSICU) for clarity, but this is different when a hospital has a neuro ICU and a Neurosurgical ICU (NSICU).

There are also Burn ICUs, Trauma ICUs, Post-Anesthesia Care Units (PACUs) and more. (PACUs may or may not count as ICUs, actually). Then there are “step-down” units, where people are “de-medicalized”, weaned from their biggest interventions before being sent to a more routine kind of a floor.

Ultimately what each hospital chooses to call each ICU is up to them. One hospital I know calls their Trauma ICU their “Emergency Ward”. Our “mothership” hospital calls their neuro ICU their Neuroscience ICU.

Oh, and children’s hospitals may have…. honestly, at least a few of these ICUs, dedicated just for kids.

I hope that helps clear things up a little bit. Let me know if you still have questions, I’ll try to help answer them as best I can!

xoxo, Aunt Scripty

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Inspiration

Set in S13b on a quiet night in the hospital, Amelia needs to share some news. The start of this fic has been sat in my drafts for like… a year?! And I finally found a reason to finish it.


Inspiration is a funny thing. I can stand and look at a brain scan for days on end and… nothing. Nothing will come to me; no answer will hit me like a brick to the face, no bulb will suddenly light up in my mind, and no neurons will ignite a fire to get my thought process to where it needs to be.

I remember Derek once calling me up and telling me (or rather, bragging to me) that he’d managed to solve a brain tumour by playing baseball on the roof of the hospital with Lexie Grey. And let’s not forget the time he thought he’d cure the lame with a design he’d seen from within his toothpaste spit.

Brains inspire me. I see their function, their shape, their texture, their abnormalities, their capabilities; I see the brain and get excited. So as I stand here and a rush of adrenaline courses through my veins, I immediately need to share my joy at having solved the brain tumour I’ve been looking at for weeks now.

“I’m amazing!” I turn around to Edwards only to discover she’s no longer there. When the heck did she leave? I look to the clock and discover it’s half past two in the morning. I’ve been standing here for longer than I thought trying desperately to work out how to simultaneously do two operations in one - one requires the patient to be awake, the other asleep. It’s impossible. Obviously. But I think I’ve come up with a fix. I just need a sounding board. That’s why I need Edwards.

I sweep my eyes over the scans one final time, narrow my eyes and purse my lips.

Keep reading

anonymous asked:

Please share more of your patient stories! I love them!

Okie dokie! Here’s a good one, I think.This one is close to my heart. 

We had this patient with multiple heart defects about a year ago. He was born, had surgery, then came straight to us. I had him for a weekend once he was stable. His dad was so, so, so in love with him. He and his wife would say goodbye to me, and then try to leave the room. But dad would just stand at the door way, staring at his 3 or 4 week old firstborn, hooked up to 2 chest tubes, a Pneumovac, on Vapotherm, a central line, and A-line. And the dad was smiling. He’s just so happy that his first baby is still alive. His wife literally had to drag him out of the room so they could go home.

This baby’s parents would watch medical shows at the bedside. They would ask me questions about the medical stuff on the show and how accurate they were. Of course I didn’t know a lot of it that wasn’t related to Peds, so I would go researching published journals on our hospital database for answers lol. We had a lot of fun together. The whole unit got to know this family very well. They were always smiling, always positive, always hopeful - but also realistic with their expectations.

This baby started to decline over the next months. He was able to go home for 5 or 6 days, then got readmitted, and never got to go home. He ended up passing away one summer night. His heart was failing, his kidneys were failing… He was brady’ing from 130 to 90 to 40 and then nothing, and then come back up to 130 and start moving around. It was so hard to see his parents go through this - watching their baby literally be on the brink of death, then spontaneously have a heartbeat again . They decided that it was their baby’s way of saying goodbye. He wasn’t my patient that night, but I was in the room helping out. I was next to his dad as he held his son, watching his heart rate go up and down. We had to pull his breathing tube out, but it’s impossible to do that when you feel your son moving in your arms, and then stop, and then move again. His son moved around, then brady’d, then stopped moving. The dad said, “Ok. We’re ready. Let’s do it.” Then his son suddenly moved and had a heart beat. And of course every time that happened he would say, “No no no. Wait. No.” Can you blame him? How could an parent remove the only thing keeping their child alive? The dad looked around the room at all the nurses and doctors around him and said, “I’m sorry. I’m sorry, you guys. I have no idea what I’m doing right now.” We all whispered it was ok. And with a shaky voice, I managed to choke out, “Nobody ever knows what they’re doing in situations like this.” He started sobbing. And I remember not being able to see anything because of the tears welling up in my eyes. Then dad finally said to his wife, with one of the most heartbreaking smiles I have ever seen in my life, “Ok, baby. Let’s do this.” He looked at the respiratory therapist and said, “Ok. We’re ready.” Their baby passed away peacefully in his arms.

That was one of the hardest shifts I’ve ever had to finish. I remember choking back tears as I documented. I remember pastoral care next to me, trying to make sure I was ok! (Kind of embarrassing. I felt like I was diverting attention to me and away from the family!) This happened months ago, and I still remember every second of that night in that room like it was yesterday. I will never forget that torn look in that dad’s eyes, trying to decided when to pull his son’s breathing tube. How does anybody ever make that decision?? 

At the end of the shift, of course, OF COURSE, the parents were all smiles, thanking everyone for everything we’ve done. The dad came up to me and thanked me for being the first friend they had on the unit, for being the first to make them feel at home. I think there was more he said to me but all I could hear was my own sobbing as I hugged him and his wife.

Like many nurses say, there will be that one patient who will change the way you practice nursing. There will be that one patient who will remind you why you do what you do. For me, it was this baby and this family. Their baby was a very, very sick patient. And no, I didn’t know everything about his treatment and diagnosis or plan of care. But trust me when I say that it is so so so much more than that. 

Meet Tanisha and Liam Honeycutt

Tanisha and Liam met in high school. He was a freshman and she was a sophomore. It was love at first sight, even though Tanisha was in the middle of one of the worst anxiety attacks of her life. Liam sat on the stairs with her, rubbing her back and holding her hand as she tried to piece things back together. They both ended up with a week of detention for being caught in the halls without a hall pass. They spent the time washing chalkboards and getting to know one another, bonding over their love of music, food and Iron Man. When Tanisha left for college, Liam was crushed, he was certain that he’d never see her again although she called everyday, twice a day and three times on Sundays.

Once Liam graduated, he joined Tanisha in San Myshuno. They got married during winter break during a ski trip to Windenburg. Three months before Tanisha graduated from San Myshuno College of the Fine and Performing Arts, she found out that she was pregnant. Tanisha’s pregnancy was rough and the quads, Rocco, Raevin, Romeo and Raenn, were born nine weeks premature. Sadly, due to complications during delivery, Tanisha was told that she would never be able to conceive again. This news devastated her, because although they’d just had four beautiful children, she wanted a larger family. Liam, although happy with the family they had, grieved heavily with his wife. After nearly 14 weeks in the neonatal ICU, Liam and Tanisha were able to take the quads home.

Since the birth of the quads seven years ago, Liam graduated college and currently works as a computer engineer while Tanisha is a stay at home mom and artist with a successful online art gallery. They are currently discussing the option of adoption as Tanisha misses the pitter patter of little feet running echoing through their apartment.   

Good Enough (20)

prologue; part one; part two; part three; part four; part five; part six; part seven; part eight; part nine; part ten; part eleven; part twelve; part thirteen; part fourteen; part fifteenpart sixteen; part seventeen; part eighteen; part nineteen; part twenty; part twenty one; part twenty two; part twenty three; part twenty four; epilogue.

bonus scenes: one, two, three, four, five, six, seven, eight.

Making sure you were fast asleep, Sehun left you under the watchful gaze of Kara and headed up to the neonatal ICU to visit Tadpole. He’d spent hours up there already with you once you had finished giving birth and had cleaned up. You just cried into his chest with your finger in the incubator as you watched Tadpole’s chest desperately rise and fall with the help of lots of tubes and wires. It broke his heart to see his daughter in such a way when she was barely an hour old but he had to stay strong for you.

Keep reading

January 1st, 2016 : 247lbs - each month I will do progress pics with weight checks ins. I will do my best to be better at posting pics of my journey along the way again. It definitely helps keep you accountable for sure.
Little a bout me if your just now catching along… I’m 26, I’ve been married for 7 years and I’ve had 3 little ones in basically 3 years. All boys so they keep me pretty busy. I’ve been a cardiac nurse, a medical icu nurse, and am now currently a neonatal icu nurse. I just recently had an appendectomy and a total hysterectomy and have moved away from all my family to TN so I’m homesick and dealing with stress and emotional eating.
I’m determined to overcome my bad habits and some day feel beautiful in my own skin!!!

Small Blessings

I was watching my husband cuddle with our son the other night, and kind of felt the need to write this little ficlet. It’s set in contemporary times. I’ll likely add other ficlets to this universe, but each should be able to stand alone.


Jamie stopped short in the hallway, pausing before he opened the door to the Neonatal ICU. The sun had set hours ago, and the ward was dark. The only illumination came from the hallway and the odd bilirubin lights hovering over some of the newborns, which cast the room in a strange blue tinge. Through the glass, he could see that Claire had fallen asleep in the recliner next to the baby’s incubator. She looked uncomfortable, as her hand was still inside one of the access ports, her finger resting on their baby’s leg.

She was such a wee, delicate thing. Perfect to look at, but tiny. She had arrived twelve weeks early, before the realization that he would have a child, a real, live, breathing, human child, had truly sunk in. Yes, he’d whooped in delight when Claire, with bright trepidation in her eyes, her voice trembling, had told him she was pregnant. When he realized what she was saying, he had grabbed her in a great bear hug and lifted her off her feet, had told her how happy he was. And he wasn’t lying, not even a little bit, though he was shocked. He’d wanted a family, had always wanted children, and knew she was meant to be their mother from almost the first time he had laid eyes on her. So when she told him that she thought she couldn’t have children after trying for years with her ex husband, he had accepted it, gracefully, he hoped, though with mixed feelings. First and foremost he was disappointed, but it was impossible to be genuinely upset when he had Claire. She made him soulfully, deeply happy, and he couldn’t bear to hurt her by letting her think she had somehow let him down. And he thought it would be lovely to have the next few years to spend as a married couple, just the two of them, since their romance was such a whirlwind. They had married after only knowing each other for six weeks. Surely they could take a little longer to start their family. Maybe in a few years they could talk to a fertility doctor, or adopt, or possibly even both.

So when she told him she was pregnant, he was floored. Thrilled, yes, but floored nonetheless. And terrified. His brain froze for what felt like several minutes, but could not possibly have been for more than a few seconds. It was long enough, though, for her to start apologizing. She was a doctor, for God’s sake, and she damn well knew better. She shouldn’t have assumed, she stammered, and she should have been on birth control. He couldn’t seem to make his mouth form words, so he stopped her blathering with an incoherent, happy yell and a tight embrace.

He’d spent the next several weeks getting used to the idea. He was happy, really he was, but in an abstract way. He didn’t really know what to expect, having spent little time around babies. Though his sister had a little boy she had named after him, he had been abroad when wee Jamie was born and had only met him a handful of times. Jenny had just had a girl, but they hadn’t had the chance to spend much time with her yet. He wanted children, but he wasn’t completely certain what to with them.

Even when Claire’s belly started to swell, reality hadn’t quite hit. It wasn’t until weeks later, when she gently took his hand and placed it on the bump, and he felt the baby move against his palm for the first time, that his heart caught up with his brain. Dear God. He was going to be a father. Soon. He was going to be responsible for a tiny human, a helpless little person who would depend on them for literally everything. The responsibility was immense. At least he’d have a few months to prepare. Then Claire had started to have contractions, much too soon, and his anxiety skyrocketed. When she started to bleed, he felt his world collapsing around him. He adored her, would do anything for her, but now, there was absolutely nothing he could do to fix it. And the baby had come nearly three months before they expected her.

Jamie silently entered the ward, nodding in greeting at another drowsy parent hovering over her child. He set his bag on the floor, bent over the plastic case, and peered at his new daughter. She still didn’t have a name, even after two weeks. The tag on the incubator still said, “Baby Girl Fraser.” They had talked about it before she was born, but thought they had more time to decide. And now that she was here, none of the names they tried seemed to fit her.

She was exquisite. The dark fuzz of her hair was covered in a little pink cap, and there were far too many wires and tubes protruding from her delicate form, but she was still lovely, and so very, very small. He stared at her wee toes and the tiny little fingers curled in sleep, and he wished he could pick her up. Instead, he kissed the tip of his finger, slid his hand through the open access port, and touched his finger to her skin.

Then he turned to his wife. Claire was stretched awkwardly toward the incubator, her right hand touching the baby, as she dozed. Her head lolled uncomfortably to the side, and if she didn’t straighten out soon, she’d have a raging headache and backache when she woke. Jamie tenderly brushed her riotous curls from her face and kissed her forehead, gently drew her hand from the incubator, then slid his arms beneath her and lifted her up as if she was a child herself. She started to wake as he settled himself into the recliner and arranged her in his lap. She murmured his name sleepily.

“Aye, lass. It’s me. I brought ye dinner. Are you hungry?”

“Thanks,” she yawned, “but not right now. I don’t think I could work up the energy to eat even if I wanted to.” She tucked her head into the crook of his shoulder and pressed her lips to his neck, and he knew that she needed his comfort far more than she needed food.

A nurse stopped beside them and leaned down. “Can I get you another chair?”

Before Claire could answer, he said, “Thank ye, but no.” He wasn’t about to let go of her. Instead, as the nurse smiled and walked away, he pulled her tightly against him, relishing the solid weight of her body, and pressing his cheek into the tickle of her hair. He closed his eyes and breathed her in, focusing on the floral scent of her shampoo instead of the antiseptic smells of the hospital. “How was she today?” He wished he could have been there, but a pipe had burst at the new distillery, and he had spent the entire day dealing with the mess.

Her body tensed a little. “Had a bit of a scare in the morning. She was having trouble breathing. I was afraid she’d be intubated, but they got away without it.”

“She looks peaceful now, but I’m sorry I wasna here wi’ you.”

He felt her shaking her head against his jaw. “You don’t have to be sorry. I’m sorry I snapped at you when you left. You didn’t deserve it. I know you would have stayed if you’d had any choice in the matter. I’m just… This is just…”

He stroked her back with his open palm, saying, “Hush, now. Dinna fash. I ken.” He felt her tremble slightly, and after a minute of silence, a wet droplet landed on his collarbone. He tipped her chin up with the crook of his finger and saw tears running down her cheeks. His heart melted a little at the sight of her glistening eyes, so wide and trusting as she looked up at him. This was the very same expression on her face that captured his soul, fully and completely, only days after they’d met. He had reacted so viscerally, had wanted, no, needed, to tuck her close against him and shelter her from the sorrows of the world with his heart and his body. After he kissed the tears from her cheeks, he asked, “Och. What’s all this about, now?”

He was actually startled at her answer. “I can’t help but feel this is all my fault.”

“What? How could it possibly be? That’s no’ possible, and ye ken that.”

She curled up against him again, mumbling into his neck. “I was working too much, too hard. It was too much of a strain on the baby. The call, those long nights, the long hours. They offered to lighten my load, but I was stubborn. I wanted to get that hard rotation over with. If I wasn’t so stubborn, if I taken better care of her…"

He cut her off before she could get any farther. “Listen to me, lass. You didn’t do this. Or did they teach you in medical school that you could stay o’ trouble by lyin’ abed for your whole pregnancy?“

She chuckled despite herself. “Of course not.”

“Then did they tell you you could keep a bairn from harm by playing housewife? Or hurt it by standing up too long? By staying up too late?”

"No…” she admitted.

He repeated, “Hush, then. Dinna fash. You’ve done naught but love her since you realized she was growing within ye.” Since he couldn’t reach her lips from this angle, he brought her hand to his mouth and pressed his lips firmly against her knuckles.

Quietly, she asked, “How can you be so calm? Don’t get me wrong, I’m so grateful. You’re my rock, you know? But how are you holding it all together?”

“Mmph.” He told her the truth while he stroked her fingers. “Because I’ve already faced my greatest fear, mo nighean donn. When you collapsed, when I saw you in so much pain, I thought I was about to lose ye both. I’ve never been so scairt in all my life. While you were on the ground, I had this, well, I guess you’d call it a vision. I saw you going from me, fading away, and just imagining it left this great void in my chest. I dinna know what I’d do without ye, Claire. I was so afraid, and I knew there was nothing I could do to help you…”

She looked up and him and started to interrupt, “But you were perfect! You didn’t hesitate a second. You got me…”

“I called for the ambulance, but that’s all I could do! I want to protect you, ye ken? I’d do anything to keep you safe. But there wasn’t really anything I could do. I felt so powerless. I’m not like you, not a doctor, nor a nurse. All I could do was hold you in my arms and wait. Did ye no’ feel me crushing you? I knew I was holdin’ ye too hard, but I couldn’t help but feel ye’d slip away from me altogether if I didna hang on tight enough.”

She lifted her hand to stroke his cheek in comfort. “I’m so sorry, Jamie. I didn’t think what it must have been like for you.”

He kissed her forehead. “You didna have the time to fash over me, Sassenach. You were quite occupied, if I recall,” he chuckled. “No, I don’t tell you this so you’ll feel bad for me. I just mean to say that I’m no’ afraid now, because I’ve already looked my greatest fear right in its face. I was so scairt to lose ye, but ye’re here. Both o’ you. Right here in my arms, and I willna let ye go. Don’t be afraid,” he whispered. “There’s the three of us now.”

Her eyes softened, and he could see that she understood. “You’re really not scared.”

He touched his forehead to hers. “You’re with me, by my side, loving me as I love you. And that gives me faith, mo ghraidh, faith in you, faith in myself, faith in the bairn. Faith in our wee family.”

He kissed her then, softly and sweetly, and would have kept on and on, hospital be damned, but he felt her lips stretch wide into a smile, and she pulled away. As Claire turned to look at their baby, she exclaimed, “That’s it, Jamie! That’s it!”

After only a moment, he knew exactly what she meant, and a matching smile spread across his face. “Aye. You’re right. That’s her, isn’t it?”

“Yes it is. Our little Faith.“

Drive-by shooting robbed baby of more than just its mother

The person who fatally shot a pregnant Toronto woman on the weekend robbed her prematurely delivered baby of more than just a mother — also gone are the child’s best chances for a healthy life.

Candice Rochelle Bobb, 35, was killed Sunday in a drive-by shooting while riding in the back seat of a car. Her baby boy was delivered by emergency caesarian section, then transported to the trauma centre at Sunnybrook Hospital, where he remained in stable condition Tuesday.

Doctors have the immediate challenge of keeping the baby alive.

The infant’s exact gestation period was unconfirmed but estimated at five months. Babies born between 22 and 26 weeks are classified as “extremely pre-term” or micro-preemie. Babies born at under 22 weeks are the most fragile of all, and have an extremely low rate of survival, according to the Canadian Neonatal Network.

If they do survive, micro-preemies face a much higher risk of chronic lung disease, intracranial (inside the skull) bleeding and an eye condition called retinopathy of prematurity, which can cause blindness, says Dr. Michael Narvey, section head of neonatology at the Children’s Hospital Research Institute of Manitoba.

The infant will usually spend the first five or six months of its life in hospital, likely needing help to breathe and eat.

In any event, it takes more than just feeding tubes and ventilation machines to sustain a baby’s development: what micro-preemies need most is a parent, according to experts.

They need contact, and especially skin-to-skin contact with their mother — so-called kangaroo care (KC), which has been shown to improve the baby’s breathing and sleep, helps stabilize the baby’s heart rate and seems to reduce pain. The Canadian Paediatric Society strongly encourages such skin-to-skin care.

“The effects of KC are dramatic and effective,” Narvey says on his blog, All Things Neonatal.

It “improves infant growth, breastfeeding and mother-and-infant attachment, which won’t happen here,” Narvey says.

It’s unclear whether the father of Bobb’s baby, or another family member, is available to step in.

But nothing can replace all the benefits — like increased immunity and resistance to infection — that come from a mother’s own milk, something that’s even more crucial for babies born prematurely than those born full-term.

Higher risk, but also hope

Down the road, extreme pre-term babies are at higher risk of cognitive, behavioural or physical impairment. One study published earlier this year in the journal Pediatrics found that more than half of infants born at under 28 weeks gestation went on to have “moderate or severe” cognitive deficits.

However, research conducted at Ottawa Hospital and the Children’s Hospital of Eastern Ontario suggests Bobb’s baby could still have a good outcome.

Of babies born at under 26 weeks gestation, the majority survive “free of disabilities or with what we would view as minor disabilities,” says Dr. Brigitte Lemyre, a neonatal ICU doctor at both hospitals who was involved in the study.

“Contrary to popular view, it’s not the majority of children born extremely premature that are severely disabled; it’s the minority,” she told CBC News. “The majority actually do well and thrive and have a very good quality of life, according to their parents and themselves when they grow up.”

It’s impossible to predict the long-term outcome of such an inauspicious birth.

“There are examples of babies who have done phenomenally well, who have no problem whatsoever, who were born at the extremes of gestation,” Narvey says. 

Officials at Sunnybrook Hospital declined on Tuesday to provide any updates on Bobb’s baby.