Episode Transcript
[00:00:07] Speaker A: Hello. Welcome back to another episode of the code 321 podcast. I have a very special guest joining me virtually today. Colleen is here. She is a respiratory therapist, and we are going to talk all about how to approach pediatric patients with the lens of a respiratory therapist, which I'm really excited about because we have not had a lot of pediatric episodes on this show, and I think that's almost a nod to how we as EMS providers sometimes can overlook our pediatric patients. It's only a small part of our training, and I think we're going to talk about why it's so important that we're good at this. So, Colleen, welcome to the show. Thanks for being here.
[00:00:43] Speaker B: Thanks for having me, Nick.
[00:00:44] Speaker A: Yeah, absolutely. If you don't mind, do you want to tell the listeners just a little bit about how you found your way into respiratory therapy and what your journey has been to kind of where you are today?
[00:00:55] Speaker B: Sure. So I had a lot of exposure to respiratory therapists because my grandfather was in and out of the hospital with a bunch of end stage COPD stuff. And I was really interested in helping and caring for patients in that way. So I looked more into the program. It was actually my second choice for the program that I ended up in, but it worked out that it was the right choice and I really love my career. I've been a respiratory therapist for 14 years and I have worked in all levels of hospitals. I've been in travel, I've worked with all patient population demographics and have really enjoyed working with pediatric patients and in the NICU in PICU.
[00:01:42] Speaker A: Yeah, that's really fascinating. I think working with those little kids as RTS is such a special experience because I know that that is like the scariest thing for me. Coming out of the nine to one field, seeing all these sick little kids that can't breathe, that was like my most terrifying nightmare. So having an RT right there was like a godsend. So thank you for doing that.
[00:02:03] Speaker B: Yeah, no, it's. There's so kids. Kids and babies are so resilient. So, you know, there's always the hard cases, but seeing, you know, kids get better is. Is always awesome.
[00:02:16] Speaker A: Yeah. And I think a lot of people forget that rts are actually a pivotal part of a lot of transport teams in other areas of the country. A lot of our listeners are from northern New England, and the standard team configuration is usually a flight nurse and flight paramedic or a ground critical care nurse and a ground critical care medic with maybe a doctor or a mid level provider sprinkled in here and there. But there are actually some programs out west and around the country that fly with a nurse and an RT or a medic. Rt doctor RT. And its really fascinating that thats being done that way. And it makes a ton of sense with all the airway complications that we run into.
[00:02:54] Speaker B: Yeah, I actually was a part of a flight program as well, that even on their adult side is a RT flight nurse, or they also have paramedics, so they'll configure some way between the three.
[00:03:08] Speaker A: Yeah, I can tell you there's been many calls in my career so far that I wish that I had an RT right next to me, because there's only. I know I'm gonna have to skype you on these really complicated calls, you know, where one lug is completely plugged with mucus and they have no oxygen, and there's nothing I can do with the ventilator. So.
[00:03:26] Speaker B: Yeah, I gotta fix for that.
[00:03:27] Speaker A: That's right.
Love that. No, I appreciate that. So, um, let's jump in and talk a little bit about, um, as an RT. When you're called to the bedside, you have a sick kid, and there's a wide variety of how people call these alerts, but generally, you know, like, a sick kid alert is a pretty common one. So you get called to the bedside, they say, hey, Colleen, we have this kid coming in. The kid is in respiratory distress, and we need you to take a look at him. Talk to me a little bit about how you would approach your assessment. What are you looking for and what's going to cue you in that, you know, bad things are happening and we need to intervene?
[00:04:01] Speaker B: Well, if I'm getting a call that the kid is sick, oh, they must be sick, because nine times out of ten, we show up and start doing an assessment, and we're like, hey, this kid's sick. So if someone knows they're sick before we get there, they either have a lot of experience in pediatric patients, or that kid is very blatantly not doing well.
So one of the main things that I do when I walk in is same thing you do with most any patient. You just do a quick oversight of the room, then glance at vitals, lock in on the patient.
I would just take a moment after my introduction and just kind of look at them for a second.
If their belly's out, that's great. It makes my first looks way easier, but if not, I eventually will start doing a head to toe assessment, and I'll get to the point where I'm going to lift up their shirt and look at their belly. So that is a really key part of an assessment in a pediatric or a patient or a neonate is seeing what their breathing truly looks like, looking at their skin directly.
[00:05:14] Speaker A: Yeah. I think with kids, it's tough because they're so resilient. You know, I've had a lot of kids in my day when I was in 901, and we're transporting them, and they just seem upset. They just seem antsy and upset, and you kind of chalk it up. As. Especially as a person who didn't have kids at the time, I kind of chalked it up as they're in a foreign environment, they're not in, you're not, they're not at home, they're not right next to mom. They gotta sit in this ed maid or their car seat. So they're gonna be a little, you know, agitated and upset. And then we get into the hospital and, you know, people are starting to realize that this kid is, you know, maybe a little bit agitated and upset because they're having such a tough time breathing. You know, even something simple like, you know, a kid with a upper respiratory infection that's covered in mucus and snot is just. They're just fighting to get through those nostrils to get some air in there. Um, and so how do you differentiate between a kid that's upset and a kid that's having a respiratory distress problem? Any tips to that?
[00:06:10] Speaker B: So, yeah, and so just to touch back for a second about, you know, how you were saying that kids are really resilient? They also just kids, you know, them not just being tiny adults. Pediatric patients compensate. Their body is meant to compensate until it can't. And when it can't, it can't. It's not like a slow decline to the point of not. Whereas, like, adult patients, where you see that compromise coming about with pediatric patients, they will be working harder, and it will be signs. It's a really learned skill. So it'll be really, like micro signs that you can see and detect in them that we'll talk a little bit more about. But when they can't keep up with those little micro signs anymore, everything just goes down, and that's when they really are really in trouble and really start to fail.
[00:07:03] Speaker A: Yeah, I think there's a. There's a couple things I remember from taking, like, pairs classes and pals classes and NRP and some of these other courses that are out there, you know, looking for the accessory muscle. Use the tracheal tugging, the head bobbing, the grunting, the nostril flaring, all of those little pieces of it. One of the things that, um, I remember from a precept, I don't even remember who it was, I'm ashamed to say. But, um, that. That he taught me was if you walk in and you notice someone's breathing or a kids breathing, there's probably an issue, because if there isn't, if there is, if it isn't drawing your attention, there's probably nothing going on. So, uh, that was really profound to me, and it's always treated me well in my career, both in nine one and now in critical care. If I walk in and I immediately I'm drawn, my attention is drawn to the sound or the rate or the rhythm of their breathing. Generally speaking, it's something I need to address.
[00:07:58] Speaker B: Yeah. And start moving a little quicker on, probably because some of those signs are.
Some of those signs are like the little micro indicative, like micro signs that are indicative of working harder. And some of the other signs are some end stage signs. For example, like grunting would be more of an end stage signal.
They're trying to generate that peak themselves. So that's more of an end stage sign. Like, they're getting to the point where they need more help and they need help now. The same with a head, like head bobbing.
An infant that's head bobbing really needs support.
[00:08:36] Speaker A: Yeah, definitely. And you're talking about the, with the peep being, you know, they're trying to splint those lower airways open, right. They're trying to keep, keep that pressure down in the lower airways to keep those velar sacks from just slamming shut and having to be reinforced, inflated every time they breathe. So definitely the grunting makes a ton of sense. And another thing that I've learned, just having a little baby and watching it grow up and going through its various stages of respiratory problems that, that we run into with little kids is, you know, treating things early with the simple interventions seem to. To kind of pay dividends. So, for example, my daughter had a really bad head cold and was really snotty. And my wife's an ER nurse and she was really, um, intense on making sure that we suctioned her, you know, every night before bed. And my daughter doesn't like that. You know, she's 14 months old, so she just hates it, you know, and, uh, but it, it cleared it up. She was able to sleep through the night, no problems. And one of the common themes I saw in admiral one is, oh, our kids been sick for three, four days. You know, it's been getting worse and worse and worse. You know, do you have any tips on some simple interventions people can do if they notice that kids are starting to have some trouble, what are some things they can do to avoid, you know, getting to the hospital, ending up in the PICU?
[00:09:51] Speaker B: Hydration. Hydration is a big one. Making sure that their child stays hydrated because as the child breathes harder, breathes more, or has the need to work harder, they lose their hydration level. Plus, also, if they don't feel great, they're not wanting to intake fluids, they're not wanting to, you know, have anything to eat or drink or anything like that. But if you notice that the diapers aren't coming like they should, or, you know, your child isn't drinking even close to what they should, that's a sign also to seek help.
But you want to just really encourage them to be hydrated. You also want to do what you had set. Nick, like with having the suction. There's a bunch of different types now out on the market. Some are better than others.
I'm respiratory therapist, so I would like it to suction a little bit stronger so I really get the good stuff.
[00:10:54] Speaker A: That's right.
[00:10:55] Speaker B: But throw a couple drops of the little saline in there.
When my kids were young, I was not a respiratory therapist yet, and I didn't read before I used the thing and I almost waterboarded one of them. So you want to really make sure if they're little, you just do a couple drops, but you get some saline in there to help loosen up the secretions in their nose and occlude one nostril while you're suctioning the other one. And just really get that out of there and just really be proactive with getting that out.
[00:11:23] Speaker A: Yeah, for sure. If anyone's ever seen the infomercial for that device called like the navage, which is always on like a HTV or whatever or whatever that channel is where you buy stuff. It's basically that device, but on a much smaller scale. And I remember when I came over to critical care, one of the things you have to do when you're on orientation is you have to go through and do rotations and all the different units, medical icus, surgical icus, pediatric icus, neonatal ICU. And then you have an entire day where you just spend it with respiratory therapists and you have a big checklist. Its like two pages of all the different skills you have to perform with RT and get signed off on. And one of them was suction. A.
Like a neonate in the NICU with this BBG suction, which were calling acorn because it looks like an acorn, which is exactly what you said. You basically put saline in one side, and then you suck the saline out of the other nostril to try to encourage that movement of saline around the nasal pharynx. And I remember, you know, working with the RT and he's like, okay, you need to do this BBG. Great. I have a baby that needs it, and he takes the COVID off the isolette, and I swear this baby's head was about the size of a tennis ball. And the baby was, like, super premature, like, like, I think it was like 1500 grams or something. And I'm like, oh, my goodness. And he's like, well, he's going to Desat a little bit when you do this, but just. Just, you know, be prepared, be quick and efficient. And the minute we pulled his ram cannula up to suction him, he started to Desat. And it was like the most terrifying thing ever. And I have a lot of respect for you guys being able to do that, because I don't think my heart can take that type of suctioning very often.
[00:12:59] Speaker B: Yeah, they. The babies that are on the ram cannulas and the nasal cpap, they get those cpap boogies. So even though they're. Even though they're humidified, there's like, they just get all dried up in there because their nose is so tiny and their nail passages are so itty bitty. So, yeah, we just had to make sure we keep them clear, Evan.
[00:13:18] Speaker A: Yeah, absolutely. No, it makes a ton of sense. So, talking a little bit about some equipment, one of the things that you and I talked about a little bit in the pre show is, you know, when I was a 911, we didn't see very many kids. And the kids that we did see were either not sick at all. It was like grandma was watching the kid, the kid starts crying, and grandma doesn't know what to do. So we go take care of the kid and bring the kid to the ER for an eval, which is usually fine, or its really, really bad, so its trauma, or theyre in true respiratory distress, or the parent waited four days too long to call us. And a lot of it was just kind of managing signs and symptoms. And I worked in an urban system where the transport times were less than ten minutes. So it was really just get him in the truck, get him moving, get him to somebody like you who knows whats going on. And so I think we kind of did ourselves a little bit of a disservice because we didnt do an extensive amount of pediatric training and we certainly didn't have, um, an extensive amount of equipment. We had, you know, the escalation of airway devices, so we had, you know, the nasal cannulas and non rebreathers, the nebulizer treatments, and then we had our advanced airways like our, you know, sgas and our, um, intubation equipment. But that being said, now working in critical care, I mean, we have an entire duffel bag filled with just initial adjuncts that we can use on kids. And then on the ground units, which are what we do our neonatal runs in, we have an entire cabinet in multiple bags just filled with different types of devices that I'd never even heard of before I came to this job. So can you talk a little bit about kind of the disparity between what we typically prepare for 901 and see versus kind of what the RT system provides in hospital?
[00:14:59] Speaker B: Yeah, so you were talking about having next to nothing or just minimum state requirements in the 911 system, and then, you know, your bags of stuff. Well, then if you get to a pick you or NICU, there's closets of stuff that can be used to treat these kids. And some of it is just like respiratory closets. It's not even necessarily mixed in with the nursing supplies and stuff so on.
In the 911 system, if you only have like an infant cannula and the kid is working really hard to breathe, you know, if it's in your protocol or if you need permission, try to get some flow on them. That nine times out of ten flow is what's going to help temporize them.
And you can, you know, you can use the cannulas, you have to get that on them to start to work. And if, you know, you're in an ER or for you, for your transport setting, I know, like, there's a lot of ers that don't see high volumes of pediatric patients that you're going to pick up and they don't have the equipment. It's not even knowledge. They just don't have the equipment to support what might be needed for that pediatric patient. A lot of I learned in my transport times, there's a lot that, you know, can't even do like a continuous nib.
[00:16:21] Speaker A: Yeah, yeah, no, I know we run into some weird nuances between the aircraft and the ground unit. The ground unit. We pretty much have anything you would want and we can pull anything we want from the hospital systems the aircraft, there's only limited space and weight, so we have to be a little bit of a Macgyver sometimes with stuff. The benefit is the speed is much faster in terms of our transport times. You're not taking a kid for 5 hours, you're taking them for an hour. And I think that comes into play when we start talking about, like, heat and humidity because it's so much more important in kids than it is in adults. And that's one thing we didn't even. I don't remember ever talking about that in any. I mean, I had six plus years of EMS training before I came to critical care, and I don't think I ever remember learning about heat and humidity for kids with airways.
[00:17:08] Speaker B: Oh, yeah, you. Because they're airways that are so tiny. You know, when you put an adult on a cannula and you throw on that normal flow, you don't think much of it because, you know, their nose is able to keep up with the level of flow that you just put on them to, you know, to at least mostly humidify the oxygen that you're sending in. But pediatric patients, the smaller, the more prevalent. They don't have the ability to heat or humidify using their nose as quickly as you're putting it in there, or as much as they might need for that demand, and they will get dried out and plug off their nose so quickly. So quickly.
[00:17:51] Speaker A: Yeah. And some of the things that we're dealing with in this critical care environment now that I'm working and we're seeing a, a lot more pediatric patients than I'm, than I was used to in 901. And the patients that we are seeing are really sick. They're patients that are going to, you know, for cardiac surgery down in Boston. They're going to sometimes pediatric patients present to their local hospital, and the local hospital, you know, basically melts down because they're, they're not designed for that. We have a lot of critical access hospitals that are several hours away from a large, comprehensive center, and they're not designed to do that.
[00:18:23] Speaker B: Right.
[00:18:23] Speaker A: And so we end up flying out there, usually, or driving out there to take care of these kids. And some of these kids are so small that we're flying them and their tidal volume is like 21 or 20 mls. And so we start to run into these weird equipment issues that the NICU is really good about, but the rest of the world isn't, which is dead space. And it's how do we assemble this adult legos of all these different pieces of airway equipment in a way where it's not going to affect the child's end, you know, um, vt el. Because, you know, I remember talking about something as simple as like inline end tidal, uh, CO2 sampling is like a huge debate with these little kids, because the, the amount of air that they're moving is so small that the sample that it's drawing is sometimes even larger than what we're delivering to the child.
[00:19:17] Speaker B: Oh, yeah, for sure. Especially the smaller, the smaller, the worse that is a problem. And then the weight of that equipment also can dislodge airways or dislodge what you're using to support the patient.
[00:19:30] Speaker A: Yeah, not to mention, I mean, these kids sometimes are in having 2.530 tubes, and those things are like, those are like the wet paper straws you get from the environmentally conscious drive thrus now. I mean, they're just like folding and bending and kinking, and it's just a nightmare to try to manage.
[00:19:47] Speaker B: And they're already more narrow than a coffee stirrer, like straw.
[00:19:51] Speaker A: So, yeah, no, 100%, um, that makes a ton of sense. And, and so, as people are starting to think about this stuff and they are hearing about it, say you're a 911 EMT or a paramedic, or you want to get into critical care, or maybe you already are in critical care, what are some things that you would recommend about how people can start to get better and get their hands on, um, this type of education and improve themselves a little bit in this field?
[00:20:18] Speaker B: So, first of all, post pandemic pediatric patients are a different breed. These kids are sick. These kids are very sick. Like, even people, you know, even me, that I'm used to it, but I'm not used to croup landing kids in the PIcu. I'm used to getting a treatment and sending home, and that's just not been the case a lot. Currently. It's, it's, these kids are sick and they're staying sick. RSV has been insanity, and it's not in a season right now. It's been like a year round phenomenon.
So also, unfortunately, during the pandemic, a lot of these pediatric assessment skills, because, again, like, it's a very learned skill set, and learned by doing, learned by seeing.
It's something that you can describe and tell someone, but it's really hard until you see it to understand. Oh, that's what they meant. That's what they were saying. And with a lot of our new grad friends that are coming out and being providers and our peers out there, they didn't get to see a lot of this hands on clinical assessment in their training due to pandemic restrictions. So some of the things you can do are to look up YouTube videos, you know, like, watch YouTube videos on kids in respiratory distress, learn what retractions look like, learn what all the different kinds of retractions look like, learn what a prolonged expiratory phase looks like, and see what it looks like in these videos, and then ask senior providers around you, respiratory therapists, if you have them around that you can work with to help educate you on these things, like to say, hey, if you get a PEDs patient, can you call me so I can come see and learn what this looks like? Because also, not every peds patient is the same, so seeing it on different peds patients is a good thing to see. And also sometimes our chronically ill pediatric patients, they to you might look like they're working hard, but their parent didn't bring them in for that. They brought them in for something else. So their parent also can be very helpful in describing what looks different.
I always say to listen to the parents or the caregiver because they might not be able to articulate in medical terms what's wrong, but they know what's different.
[00:22:51] Speaker A: Oh, yeah, definitely.
[00:22:53] Speaker B: Having a discussion with them about what's different on their level not only helps you understand what is going on, but it also helps them kind of calm down and be able to communicate with you what is happening. And so a calm parent leads to a calm patient, and calm pediatric patients are the best ones that you want, like, because they're the ones that your interventions are going to help the most. And, yes, it's scary. Yes, they're cranky, but if they're really having trouble breathing and then you give them support, you kind of watch them be like, oh, this isn't so bad.
They won't want the cannula on, they won't want the support. But then you get it done, and they're like, wow, this helps me. Okay.
[00:23:47] Speaker A: Yeah, it's really exciting when we go pick up these NICU babies and they're really in distress at these critical access hospitals, and they're working, they're doing the best that they can, but they just don't have the equipment and the experience and the availability to treat that. And then us and the NICU team show up and we get them moved over onto the right therapies. You put them in the nice, warm isolate, and you start driving down the road, and almost every single one of them has a nice, relaxing nap with perfect vitals the rest of the way back because it's just like the perfect blend of warm. They're being oxygenated, they're tired from this whole event that just went down. And now they're kind of being like lulled to sleep. And I like being able to share that with the parents because a lot of the times the, the mothers have just delivered, so now they have to get transported by another unit and their kid is sick, especially if it's their first kid, there's all the stress and anxiety and to be able to, you know, wheel the isolate by them and show them its like, listen, theyre going to take a nap and theyre with the best team in the region right now. Were going to bring them, theyre going to have a great time. Its going to be good. Were going to take care of it. So that brings me a lot of joy, to be able to be part of a unit that provides that level of peace and calm in an environment where theyve been so stressed for probably the last 6 hours while this has all been developing.
[00:25:01] Speaker B: And not only that, the providers that theyre watching are also stressed because this isnt their normal, this isnt whats supposed happen. Right. So now they're stressed, they're scared and they can be, they can, you know, try to explain as much as they can to the parents, but, you know, you sense it. Like you sense someone not being able to fully explain to you maybe what's going on and it's scary and it's not supposed to what's, it's not supposed to have been what's happened. And a lot of the times if they're delivering at one of these facilities, what led up to us being called is a series of unfortunate events that just weren't supposed to happen and it wasn't what they pictured happening.
[00:25:42] Speaker A: Yeah.
[00:25:43] Speaker B: And, you know, they're scared and so being able to get there and I agree, like, being able to get there and, you know, get their baby stabilized so that you can take it by their room and be like, hey, this is who we are. Here's your baby. Happy birthday. Like, congratulations.
You know, I know this isn't what's supposed to have happened, but we're going to take care of, you know, your, your baby the best we can and get them to where they're going to be able to get the, the best support and help that, that there is to offer.
[00:26:15] Speaker A: Yeah. And one thing I've been trying to do a lot of in my critical care world especially is if we're working with family like that or there's family in the room, whether it's a little baby or even just an adult, I'll ask if there's any questions, and then I'll give just a very basic rundown of what's happening. Because one of the things I've noticed is that sometimes the family is kind of overlooked because everyone's so busy with what we're doing. No one ever explains anything to anybody. And sometimes when you, when you, even if you say, hey, do you have any questions? They may not know what to ask, but something I learned in my nine one days is kind of just a quick rundown of, hey, they've been put on the ventilator because we want to support, you know, healthy lungs. And, you know, we're going to be providing them with a little bit of medicine to keep their blood pressure up. We're sedating them. So if they're not as responsive as what you saw earlier. Earlier, it's not that they're getting worse. We chose to do that. We chose to make them more sleepy so that when we fly them for an hour and a half, it'll be comfortable and relaxing for them. It's like little things like that. Because sometimes I've noticed, you know, family members are like, oh, man, they were, they were kind of awake a minute ago, and now they're not awake. Like, what happened? Are they getting worse? And it's like, no, no, we, we did that to make it more comfortable for your family member. And they're like, oh, thank you. Thank you. Thank you. So, like, sometimes I find that, you know, even the providers at the bedside, they forget that little piece of just letting people know.
[00:27:36] Speaker B: Right. And I think a big thing with that, too, is, and something I've learned throughout my career is that health literacy also doesn't translate to your level of education.
[00:27:45] Speaker A: Yeah.
[00:27:46] Speaker B: And health literacy is something that's very wide across our country and, and whatnot. And also when parents or caregivers are in this situation where their child is sick, they essentially get a tunnel vision. And I really like to talk to people at, I don't want to say a low level, but I like to talk to people at a level that they can understand in a stressful situation.
And if they choose to ask a question that's maybe more clinical oriented, then I'll answer that. But I try to make it very basic but informative.
So also, I'm not overstimulating them even more, but giving them the information that they need so that they can understand what's happening?
[00:28:36] Speaker A: Oh, definitely, yeah. Make them part of the situation and help them understand what's going on around them. Because the worst thing you can do is like the old school 20 years ago cardiac arrest thing where you just, you know, shuffle the family into another room and you say, stay out of the way, we'll let you know what happens. And then you come back and say, know, you know, it didn't work or whatever. You want to let people know what's going on. You want to explain what's happening. And I have seen, you know, these parents with these sick, sick babies and you just take five minutes and you say, hey, here's where that provider over there is the nurse practitioner. She's in charge of the NICu tonight. She's over here taking care of your baby. Her name is Meg. You know, this is the nurse. She specializes in neonatal care. She works in the neonatal intensive care unit. And this is a respiratory therapist. Its colleen. Shes great. Shes worked for 14 years, worked with all different types of patients. Were going to take really good care of your baby. Like just little things like that. And you watch like this thousand pound weight just melt off their shoulders because no one thought to do that, you know, or took a second to just do that for 30 seconds.
[00:29:39] Speaker B: And sometimes the smaller hospitals, maybe they dont have the bandwidth or maybe they dont have, you know, the ability outside of what they've already done, which is understandable, it's fine. But you're right. Like I've never, I would say less than five times in my, you know, career and trans, I have had several years in transport like that. I've not been able to either swing by the mom's room or at the very least have the mom be brought to me, I think there was like two times where the mom just wasn't stable enough to come either.
[00:30:21] Speaker A: Yeah.
[00:30:21] Speaker B: Or wasn't stable enough for us to interact with. But like there's essentially always time because again, like you want your patient stable for a transport. So if, you know, they're not stable enough for your transport to stop by mom's room.
[00:30:37] Speaker A: Yeah.
[00:30:38] Speaker B: What can you do where you are to make them stable for where you're going?
[00:30:42] Speaker A: Yeah, we got to think about it a little bit. If there, we talk a lot about that with the helicopter, you know, like if, if they're not stable enough for us to make it where we're going, why are we taking off? Like if we carry blood, if we carry all the interventions and invasive procedures and all these other things like there's a lot of times where me and my partner will look at each other and be like, are we doing this, or are we going to sit here for a minute? And sometimes we have to sit there. I mean, I remember a patient not too long ago, maybe a month ago, me and my partner, we could not get a blood pressure, and we couldnt palpate any pulses we had. We knew that they were, you know, they were breathing. They were triggering an event. They had, you know, they had really, really poor cap refill, but we had a, you know, ciras complex that was tr, I mean, we knew that they were alive, but we couldnt get blood pressure. And we just, we waited and put it in our line because were like, we, we cant take off with someone with no blood pressure.
[00:31:32] Speaker B: Right.
[00:31:32] Speaker A: We like their quadruple pressed right now. We cant do that. And so sometimes you have to take a minute, and I've been on NICU calls where it's 20 minutes at the bedside and they're ready to go. And I've been on NICU calls where it's 4 hours because it's just, you know, you gotta get them, you gotta get them stable enough to move, and the last thing you want to do is take these little, tiny premature babies and load them up and then leave your only support system to go out where there's no cell service for 3 hours to try to make it to the next level.
[00:32:01] Speaker B: Oh, for sure. Go in a closet and you have enough room. Not like a new walk in closet. Go in, like, a coat closet and see if you have enough room to maneuver to do all these things if you don't stay in flight.
[00:32:15] Speaker A: Yeah. No, exactly. I always tell people when they ask what the work on the helicopter is like. I'm like, imagine you're sitting in your kid's car seat and you're making a five course meal. That's essentially what it feels like.
[00:32:25] Speaker B: An excellent description.
[00:32:27] Speaker A: Well, Colleen, I appreciate you joining me tonight. Thank you for sharing your wisdom, and I hope that you stay safe out there and continue to do great work on the front lines.
[00:32:38] Speaker B: Oh, thanks. You tuning all right?
[00:32:40] Speaker A: Thanks, Colleen.
