My Night on Pediatrics
My heart is still pumping. It’s about 4 in the morning, and I just finished in helping resuscitate a baby.
I had fallen asleep in the call room at around 2 am after examining six newborns that were born back to back through the night. At about 3 am, I was rudely interrupted by my “baby pager” obnoxiously beeping away. The voice on the other end screamed into my pager, “Please come to Room 14 for prolonged decels. Room 14 for prolonged decels.” I crawled out of bed and rushed to the room. No supplies were set up, so the NICU nurse, Respiratory Therapist (RT), and I quickly assembled the equipment.
Newborn resuscitation bags/face mask/oxygen tubing – check
Delee/connection tubing for suction – check
Bulb suction – check
Scissors – check
Endotracheal tubes/stylets x2 – check
Laryngoscope handle and blade – check
Meconium aspirator – check
As we were working on the neonatal supplies, the Ob/Gyn resident was attempting to deliver the baby. The laboring mother was a 40 year old Hispanic G4P3 (interpretation for all you non-medical people: Gravida 4 = has had a total of four pregnancies, irregardless of whether they were carried to term; Para 3 = has had 3 viable births) whose last baby was born about 11 years earlier. All of a sudden, the baby’s head was seen to be out of the birth canal, but it was stuck! A nuchal cord was present (umbilical cord wrapped around the neck), which was essentially choking the newborn and preventing the body from coming out. Everyone seemed to go into a panic. The Ob/Gyn resident began shouting at the mother, “Push! Push! Empuja!” Two delivery nurses jumped onto chairs and began pushing down on the mother’s uterus. The resident was pulling on the baby's head with all her might. The laboring mother’s husband and sister were frantically encouraging her to push. I watched helplessly in the background and silently offered up a prayer to heaven for the mother and baby, that all would go well.
After what seemed like an eternity, the baby was extracted! It was a girl! The Ob/Gyn resident quickly clamped the cord and brought the baby to the infant warmer where I was standing. I had never seen such a miserable looking baby. She laid completely apneic, blue from her head to her toes, as floppy as could be. The RT tried to intubate the baby. The nurse tried to stimulate the baby. I listened for her heart rate. Greater than 100! Those were the only 2 points she earned on her 1 minute Apgars. The intubation attempt failed the first time, so we decided to simply bag the baby. We vigorously cleaned off the baby with warm blankets, trying to stimulate her to cry, and suctioned out her nose and mouth. In the middle of our resuscitation efforts, the aunt cried out, “Is she okay? Why isn’t she crying?”
“We’re working on it,” was all I could say.
After what seemed like another eternity (perhaps about 30 seconds after we started the oxygen), the baby finally began to cry. I realized that everyone in the room must have been holding their breaths, because at that moment I heard the strange sound of a collective exhalation.
We delee’d the baby (suctioned out her mouth/stomach), percussed her back, and continued to bulb suction her mouth and nose. Fortunately the baby did well after that, receiving a final Apgar score of 9 (out of 10). Her color was now a pinkish hue, her tone was good, and her cry/respirations were vigorous. As I left the room, I breathed a prayer of thanks to our Lord for saving the life of yet another baby. It was a close call. My heart is still pumping.
I had fallen asleep in the call room at around 2 am after examining six newborns that were born back to back through the night. At about 3 am, I was rudely interrupted by my “baby pager” obnoxiously beeping away. The voice on the other end screamed into my pager, “Please come to Room 14 for prolonged decels. Room 14 for prolonged decels.” I crawled out of bed and rushed to the room. No supplies were set up, so the NICU nurse, Respiratory Therapist (RT), and I quickly assembled the equipment.
Newborn resuscitation bags/face mask/oxygen tubing – check
Delee/connection tubing for suction – check
Bulb suction – check
Scissors – check
Endotracheal tubes/stylets x2 – check
Laryngoscope handle and blade – check
Meconium aspirator – check
As we were working on the neonatal supplies, the Ob/Gyn resident was attempting to deliver the baby. The laboring mother was a 40 year old Hispanic G4P3 (interpretation for all you non-medical people: Gravida 4 = has had a total of four pregnancies, irregardless of whether they were carried to term; Para 3 = has had 3 viable births) whose last baby was born about 11 years earlier. All of a sudden, the baby’s head was seen to be out of the birth canal, but it was stuck! A nuchal cord was present (umbilical cord wrapped around the neck), which was essentially choking the newborn and preventing the body from coming out. Everyone seemed to go into a panic. The Ob/Gyn resident began shouting at the mother, “Push! Push! Empuja!” Two delivery nurses jumped onto chairs and began pushing down on the mother’s uterus. The resident was pulling on the baby's head with all her might. The laboring mother’s husband and sister were frantically encouraging her to push. I watched helplessly in the background and silently offered up a prayer to heaven for the mother and baby, that all would go well.
After what seemed like an eternity, the baby was extracted! It was a girl! The Ob/Gyn resident quickly clamped the cord and brought the baby to the infant warmer where I was standing. I had never seen such a miserable looking baby. She laid completely apneic, blue from her head to her toes, as floppy as could be. The RT tried to intubate the baby. The nurse tried to stimulate the baby. I listened for her heart rate. Greater than 100! Those were the only 2 points she earned on her 1 minute Apgars. The intubation attempt failed the first time, so we decided to simply bag the baby. We vigorously cleaned off the baby with warm blankets, trying to stimulate her to cry, and suctioned out her nose and mouth. In the middle of our resuscitation efforts, the aunt cried out, “Is she okay? Why isn’t she crying?”
“We’re working on it,” was all I could say.
After what seemed like another eternity (perhaps about 30 seconds after we started the oxygen), the baby finally began to cry. I realized that everyone in the room must have been holding their breaths, because at that moment I heard the strange sound of a collective exhalation.
We delee’d the baby (suctioned out her mouth/stomach), percussed her back, and continued to bulb suction her mouth and nose. Fortunately the baby did well after that, receiving a final Apgar score of 9 (out of 10). Her color was now a pinkish hue, her tone was good, and her cry/respirations were vigorous. As I left the room, I breathed a prayer of thanks to our Lord for saving the life of yet another baby. It was a close call. My heart is still pumping.
posted by janie and paul =) at 4:07 AM
1 Comments:
thanks for sharing...PTL for a happy ending. hope you got some rest after...ttyl
Post a Comment
<< Home