Thursday, January 28, 2010

Gammaguard face

Last week we had a Guillian Barre Syndrome case which required IV immunoglobulin (IgG). SN L was in-charge that afternoon, with me and SN RB taking teams. SN L is relatively new as the in-charge, and both SN RB and myself are less than 1 year old at the ward. Unfortunately, ICU was full due to several Code Blue cases, thus we had to nurse this case in at the ward instead of ICU. SN L put up the telemetry for ICU auto-monitoring. An ICU nurse, SN R, came to assist with the 1st 5-10min of IV IgG. The 9 year old patient was under the care of my team, so I spent the 1st 15min monitoring her by the bedside, and thereafter close monitoring following ICU's usual practice. When her 2nd dose of IV IgG was due, I was again there to start it.

Today we have a Kawasaki case which also required IV immunoglobulin (IgG). The ward manager was in-charge this morning, followed by SSN R [as in-charge] this afternoon. Both I and my runner senior HCA M were on double shift, taking the team caring for the Kawasaki patient. This child is autistic and his mother felt that he could not be acclimatised to the ICU environment. Thus, treating him in the ICU would entail heavy sedatives or restrains. In the end, the decision was made to nurse him in the ward instead of ICU. This time round, it is a bigger risk. The child's mother insisted that the child would pull-off any telemetry device and any attempts to take his BP would agitate him beyond control. Even setting the IV plug and keeping it on him for the duration of IV IgG would be a challenge. Thus it was back to old-fashioned nursing, with visual assessment of his alertness, responses, respiration rate and the occasional pulse rate assessment. Thankfully everything went smoothly.

Our colloquial term for IgG is Gammaguard. At the end of the shift, SSN R joked that both of us have the "Gammaguard face". I surely seem to have double the luck, for I was there to start both the initial IV IgG.

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