When I don't have an exact work schedule, I tend to get my days mixed up. Although I tend to work every other weekend, I don't work the same days during the week. I worked Tuesday 7am - 7pm and it totally felt like a Sunday to me.. so on Wednesday (yesterday), I thought it was Monday. I knew it wasn't Monday, but I had it in my head all day long that it was.
Yesterday (my day off), I spent 8 hours at work for mandatory neonatal resuscitation. CPR on a newborn (full or preterm) isn't like cpr on an infant/child or adult. I had just renewed my life support certification a few weeks ago, so those numbers were stuck in my head (the numbers have changed for those of you that don't know, along with a few other cpr changes) so with those numbers stuck in my head, it was a little difficult to remember a whole new set of numbers and sequences when dealing with a newborn. It's probably a good thing this class was 8 hours because it took just about that long for things to sink in with me. Now comes the actual resuscitations and written testing. If I didn't hear anything else during those 8 hours, I did hear "everyone passes". Maybe they shouldn't tell you that, because you may be less likely to pay attention and not allow yourself to daydream the hours away.
I also heard this; "the physician or nurse practitioner will insert the umbilical catheter into the umbilical vein with a large bore needle for medications (epinephrine) and volumes (fluids)" ... sounds good to me. I can concentrate on positive pressure ventilations, gas exchanges, oral intubations and chest compressions while someone else puts in an umbilical catheter... cool deal. I had finished my written test (100 questions) and proceeded to enter the room where six stations were set up, fully loaded with infants and all the materials needed for neonatal resuscitation... I took a seat and watched until there was an area available for me to "perform". I watched a few instructors put their student in a situation where they needed to resuscitate their newborn (not all situations were the same) and after watching them for awhile, I knew exactly which two instructors I wanted... E.Z. I hadn't paid much attention to the instructor to my left, I just knew the "student" had been with her for awhile. Two other scenarios had come and gone to the right of me, while this one student continued with her instructor to the left.
I heard "next". It was coming from the left. I looked her way and smiled, while pointing in the direction of the instructors to my right, basically saying "no thanks, I'm waiting for this station" with my facial expression.
So she said "I'm ready, come on over".
Well what am I going to do now? DEMAND that she get someone else?
I should have.
Not only did she think of the worst possible situation that a newborn could get in to, she gave me an extremely premature newborn with every problem known to man ... just when I thought I was finished resuscitating this poor baby (full intubations, ventilations, chest compressions and I even gave it some epinephrine down it's endotracheal tube AFTER I inserted an orogastric airway into it's stomach to relieve some of the air pressure), she then stated this baby needed volume and additional epinephrine! What the...
So the part during instruction about umbilical catheters was a blur only because she said a PHYSICIAN would be inserting it, I suddenly had to do. I figured how hard could this be.. there are only 3 vessels in an umbilical cord (2 arteries and 1 vein) ALTHOUGH some babies only have 1 artery and 1 vein. I knew the vein would be bigger than the 2 arteries so I catheterized it, while she cocked her head to see what I was doing... then she's like "ok how much epinephrine?" and "this baby is 3 lbs, so how much volume will we give due to blood loss, or if you prefer not to give lactated ringers, what else might you give the baby?"
Crap.
Me: "I could give it O negative packed red blood cells"
(where in the hell did that come from?)
Her: "that's right"
Her: "and what else could you give through this umbilical IV that you wouldn't give through the the endotracheal intubation tube?"
Me: "sodium bicarbonate?"
Her: "exactly"
My brain retained things that I wasn't really paying attention to after all!! I spent half the time (instruction portion) watching hot guy 3 tables over try to open a bag of Lays potato chips quietly... it took him well over half an hour to finally get the entire top of the bag open far enough to reach his hand into. (the girls at my table were enjoying this entertainment) and then we continued to watch him shift in his seat.... almost doze off... text something with his cell phone.. stuff like that.
So that was most of the day yesterday. Oh, they also had it so cold in those rooms that we were actually shivering. I drank 3 cups of hot cocoa.. put on a sweater AND thought constantly about going home and getting into a super hot bath. It was a beautiful scene to finally leave there and open the doors to the 83 degrees outside. I instantly felt better.
