Kathleen Guhl - Pacific Medical Training

Submitted 2022-11-01

It was 7:15am. I had a fresh coffee in one hand and my stethoscope in the other. I had just received report from the off-going nurse on my six patient, three couplet, assignment. Each couplet seemed to be progressing well, with no acute events reported overnight. At the time, I had about two months of experience as a Mother-Baby Registered Nurse at Tampa General Hospital, and I was just beginning to feel confident in my abilities. 

Going about my morning like normal, I began rounding on each patient by checking vital signs and performing head to toe assessments on both my postpartum mothers and their newborn infants. About an hour later, two couplets had been seen and I had one couplet left to assess. I sat down to chart an infant feeding session when my work phone rang. “Mother Baby Unit, this is Katy, how can I help you?,” I said in between quick sips of coffee. “Katy, it’s Erica, the Patient Care Technician. The baby in 408 doesn’t look right, can you come check him out?”  She sounded concerned. “I’ll be right there,” I said in a hurried tone, and quickly rushed to room 408.  When I got to the room, I saw that the infant’s mother was distraught. In Erica’s arms was a baby boy, who no longer had the pink skin color he had during the bedside shift change report. He was dusky blue. He was breathing, but was making singing sounds with each breath, which I knew was a sign of respiratory distress in infants. Thinking the infant may be partially choking on secretions, I quickly grabbed the infant and the bulb syringe. I sat the baby up and suctioned his mouth while vigorously patting his back. About 10 seconds passed, and the infant’s appearance was not improving. 

I calmly looked over to the infant’s mother and said, “Ok mom, he’s having a little trouble breathing. I am going to take him down the hall to our procedure room where we can give him a little extra help.” I simultaneously glanced over to Erica and made eyes at the emergency staff assist button on the wall. Erica automatically understood what I was telling her, and she pushed the button on the wall. Within seconds, multiple nurses, including my charge nurse, were in room 408 and we rushed the infant down the hall to the procedure room. 

I laid the infant on his back on the infant warmer and put a pulse oximeter on his right hand. The oxygen saturation read 82%. I promptly looked up to my charge nurse, who was already turning on the oxygen machine and performing blow-by oxygenation on the infant. The infant’s heart rate, axillary temperature, and blood glucose were all within normal limits. Upon further assessment, the infant was tachypneic, retracting, and still cyanotic. I called out to Erica and asked her to begin documenting times and events. I also asked my co-worker to call the NICU emergency team and the pediatric resident on-call. Soon, the blow-by oxygenation was working, the infant’s color was improving, and the physicians were at the bedside. 

Once the infant was temporarily stabilized with the help of supplemental oxygen, the physicians made the call to transfer the infant to the NICU for further monitoring, testing, and to start the infant on a CPAP machine. My coworkers watched over the infant while I went to get his mother. When I got to her room, she was pacing around and sobbing. I brought her to her newborn’s bedside so that the physicians could update her on her son, and let her know what the plan was. I told her she was more than welcome to come with us as we transferred the infant to the NICU, and she did; she didn’t leave her son’s side once. 

My advice to people going into the medical field is that you don’t need to know everything, but you do need to know who to go to when you don’t know. In my example, Erica knew something was off but didn’t know what, so she got into contact with me. I then knew the infant was in respiratory distress and needed supplemental oxygen, but didn’t know how to begin blow by oxygenation. I had never needed to start it before, so I never learned. I did know where the oxygen was located, and I did know who would know how to start blow-by, and immediately got their assistance. Further, I didn’t know what was causing the infant’s oxygen to drop, but got into contact with the physicians who were able to order tests and diagnose the infant with a congenital heart defect, saving the infant’s life. 

Lives are saved when healthcare workers know what they know, and more importantly, know what they don’t know. Lives are saved when healthcare workers are willing to ask for help and work as a team.