Wednesday, September 28, 2005


Double whammy Friday night: Charge nurse AND admissions. Sometimes it's entertaining.

The shift started with a bang -- 2 high risk deliveries. First one, no problem. Second one, C-section. Baby was nice and pink, but wouldn't stop grunting. In case you've been out of pediatrics for a while, that's a behavior newborns display when they're struggling to get or keep their lungs fully expanded. The nurses in the well-baby nursery, very wisely, will not accept babies engaging in this particular activity. We suspected that this baby was just slow making the transition from intrauterine to extrauterine life, but after 15 minutes of stimulating (making him cry), suctioning (also making him cry), and applying PEEP (positive end expiratory pressure to help expand the lungs -- and make him cry), we decided that we'd have to take him back to the NICU with us.

Once there, we made the baby cry some more by drawing blood to send to the lab. This is jokingly called a "theraputic" workup when the baby ceases all disturbing behavior (grunting) after being caused to cry so much. Net result, we had a CBC (complete blood count) which had some minor deviations from the norm (13 bands) and a baby who was, by then, asymptomatic. The neonatal nurse practitioner on call decided to repeat the test in the morning, but went to bed without actually writing the order and I hustled the little guy back to the waiting arms of his mom - still in the birthing center.

6 hours later, the first year pediatric resident covering the well baby nursery sauntered into the NICU in search of the nurse practitioner. He allowed as how he wasn't sure whether to wake her, since she attended the delivery, or his senior resident. On the advice of the NICU staff, he was about to go wake his senior resident when I thought better of that suggestion and asked him which baby was causing concern. Baby #2, of course.

Since his concern was focused on that CBC, I thought I could put his mind at ease by assuring him that the nurse practitioner had already decided to just repeat the test. He was almost convinced, but there were these complications:

The baby was still asymptomatic, but there were factors in the mom's history that worried him. Did he know something we didn't? After reviewing his list of concerns, we found only one thing the nurse practitioner hadn't known - but we really don't worry about abnormal pap smears. He's certainly thorough - and concientious. He even listens to nurses. I think he might be a keeper. Oh and he did go order that repeat CBC.

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