Back On The Night Train

So after a four week reprieve, I'm back to working nights. With the new expansion spreading the patients out and our likely brief lull in patient acuity, there's a feeling of relative calm about the unit so far tonight. Our numbers right now are in the low 50's, and only 2 or 3 on ventilators. Sure a problem or two pops up here and there, but right now we're strokin' along on an even keel. I even had some time this week to catch up on some administrative tasks including catching up on resident evaluations and completing all of my medical records! I feel certain that this week will provide some excitment. Perhaps right now we're experiencing the calm before the storm!

I am currently attending a lecture geared towards teaching how to teach resident physicians. I am quite active in resident education. Teaching adults is different from teaching children. So here I am after work on a Thursday learning how to teach adults!

Tracheoesophageal Fistula

I'm caring for an interesting patient who has what's known as a tracheoesophageal fistula. This is basically a situation in which the trachea (otherwise known as the windpipe) and the esophagus (the food chute) are connected by a small passageway. It occurs in about 1 in every 4500 live born babies. My patient who is only mildly premature, started having some unexplained respiratory distress especially with feedings. It was also noted that there was difficulty passing an orogastric tube. On xray, the tube was noted to be coiled in the upper esophagus (a situation which is diagnostic of TE fistula).
Most patients with TE fistula have a short upper esophagus which ends in a blind pouch (a problem called esophageal atresia). They also have a lower segment of esophagus which connects with the trachea and the stomach. Occasionally, there will be a continuous esophagus and trachea which are connected somewhere in the middle (this is known as an "H-type" fistula).
To correct this, a surgeon enters the chest cavity and closes the connection between the trachea and the esophagus. He then attempts to connect the two ends of the esophagus. Sometimes, the two segments of esophagus are too far apart and some growth is required before esophageal connection can be done. If this is the case, then a tube is surgically inserted through the skin into the stomach (called a gastrostomy tube) as a method of feeding until the child is big enough to connect the two ends of the esophagus.
My patient had his trachea and esophagus separated surgically and was able to have his esophagus repaired during the same operation.

If You Build It, They Will Come... Eventually...

So after struggling to keep our heads above water for several months with too many babies and not enough beds, the new, improved, expanded, NICU opened. Of course, due to a lot of discharges and fewer admissions, we're at our lowest census in months! That's the way it always works, and hey! I'm not complaining. It's nice to have a bit of a break from the hustle and bustle of a unit that's filled to maximum capacity!
Moving day went smoothly with all equipment transitioning seamlessly. Of course, the massively expanded space left me wandering aimlessly at times looking for the new location of my patients. Our maximum number went from 56 to 79 with the addition of three lengthy hallways and a command center reminiscent of Mission Control. I'm now able to navigate the new terrain with some feeling familiarity especially with the reassurance of having a GPS on my cell phone. It's also nice to be getting a healthy dose of exercise during rounds!
All joking aside, the new unit is very nice and state of the art. I'm very excited about having the space and resources to take the best care of patients possible!