The holidays in our unit are always busy. We don't have a good reason except that the surgeons always plan some time off, so want to get in as many OR cases as possible before the holidays.

Families will schedule elective surgeries during holidays because they have time off, kids have time off.

Babies are always born during the holidays and Ob's schedule c-sections either before or after the holiday. Some of these babies have heart defects that come in emergently. All these factors and the fact that nurses want a little extra time off, make for a busy unit with low staffing.
This is actually a view of the front of the hospital. Now there is a whole new hospital going up beyond the front entrance. We are planning on moving in 2010. My unit is actually off to the right just out of camera range. But, back to my shift. Here I enter the hospital. Come on with me, I don't want to be late!

Ok, first words I don't want to hear coming in the unit to get my assignment, "Oh, I had to change your assignment from last night, this patient is REALLY sick!" The next thing I don't want to see, is my patient's room full of doctors talking over my patient! Looks like it's going to be a fun night!
I get report from the day shift nurse as he is busy catching up and I try to help out and catch up on a little history and the events of the day. The parents are huddled in the corner with the ICU attending getting "the talk". You know, what is going on, what can be expected. worse case scenarios,. . . . and then we hear it, and we might have to put your baby on a machine" We knew that was coming!
But, let's get started! So, we work hard at keeping this 3 year old little bundle of these parents joy off the machine. We give fluids, we give drugs, we titrate the IV drips, we adjust the ventilator, get Xrays of the lungs, send blood samples. After 2 hours, it is just is a losing battle and we call "the team". . . Surgical fellow and attending, OR team, perfusionist. Within the hour this is my room. Fortuanately, my patient has not coded! I have practically not left her bedside, her life line for 45 min. pushing fluids and adjusting her IV meds to keep her little heart pumping sufficiently and her little lungs sufficiently inflated.

The team is here! Our good hearted friendly surgical fellow is a 5 ft. woman from India! We love her! She is always calm, confident and easy going! I move to the head of the bed with the ICU fellow to be anesthesiologist and nurse providing sedation, pain control and blood products as needed. I notice both of us have on the usual 3 layers needed to keep warm in the unit at night. Now, we have added the layer of OR garb, hat and mask. The ICU fellow up at the head of the bed with me, a tiny Japanese woman, and I see her forehead glistening and we trade jokes about who is the most uncomfortable as I hand her a syringe full of blood to push and I ready a dose of epinephrine. The OR team sets up the field right in the room and the surgery begins. The perfusionist sets up the ECMO machine. The ICU and surgical attendings stand back and let us go to work and offer knowlege as needed.

WARNING!!! Surgical shot coming!




Being at the head of the bed, I get a birds eye view of the cannulation of the aorta! This cannula will feed back oxygen rich blood to the body after being enriched by the ECMO pump.




The ECMO pump after being set up and connected to the patient is run by a nurse. One nurse mans the pump, the other nurse cares for the little girl, that would be me. My partner tonight will be Alex. He will be the pump nurse. This is a relatively new pump we use exclusively in our unit. We moved from a roller head pump to this new centrifugal pump. It is smaller and faster to prime.
We take blood samples from the pump and from the girl at the same time and make pump adjustments based on those results. We also determine what blood products the little girl needs from lab results. All night, we work on correcting these and by morning we have a spot perfect result!!



So, we are weaning down much of her support as the pump does the work of her heart and lungs. They "rest" for an anticipated 5 days. Hopefully, in that time, she has recovered and will come off the pump!

We give report to the oncoming nurse! That was 48 hours in 5 days, I'm done. Let's go home!