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Wednesday, May 15, 2013

Transport Team Series! - What Would MacGyver Do?

Today we are beginning a new series from our Transport Team. They travel the world (literally!) to bring extremely sick children to our Hospital. Today's post is from Megan Monahan who is a highly skilled Respiratory Therapist and member of the team.

Walking into the room of a 9 month old with possible epiglottitis would make anyone cringe, much less knowing you’re going to be the lone airway resource for her ride back in a 5 foot by 10 foot enclosed environment 1500ft above the earth in a helicopter!  She was fast asleep on her Mom’s lap and had no IV access.  She also had a previous respiratory history that could explain away her stridor and hoarse cough.   
As we decided her plan of care for transport back to All Children's Hospital, we knew one thing; please don’t wake up and start crying! 
I decided to try a racemic epinephrine treatment while she was still sleeping in hopes of reducing her inflammation.  She didn’t exactly wake up, but kept moving her head side to side trying to get away from the blow-by mist.   I asked the bedside nurse for a styrofoam cup to hopefully help her tolerate the treatment.  Like a scene from MacGyver, I punched a hole in the bottom of the cup, creating a make-shift mask. 
This was working; she was sleeping right through the treatment or so we thought.  While discussing the necessity of an immediate surgical intubation if this was in fact epiglottitis, we ironically held our breath as the little girl woke up. Would she cry? Would she get worse? Would she stop breathing? No way! 
Instead she sat wide-eyed and happy on Mom’s lap.  She then grabbed the cup and moved it right in front of her face, just like a face mask should be.  She finished the treatment like a champ, and when I went to take the cup away, grabbed for it like her new favorite toy.  Smiles and giggles resulted because of this toy. They even replaced tears when we had to start an IV. This new "toy" accompanied us all the way to her bed at All Children’s Hospital. 
After 2,000 college hours and 22,000 clinical hours, who would think my most important tool would be a white styrofoam cup?

Keep watching for future posts from our Transport Team!
- Jay



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