Looking after precious patients in the PICU
By Debra Guinn, MD, maternal-fetal specialist, Montana Perinatal Center, and Margaret Satchell, MD, pediatric intensivist, Kalispell Regional Medical Center
Every parent endures illness in their children. Usually these illnesses are fairly short-lived and may include colds, ear infections and minor injuries. It’s part of parenting to take a sick child to the doctor for evaluation and treatment, then to care for and comfort them through recovery. In some cases, an illness or injury requires hospitalization. In some even rarer cases, that hospitalization may require time in the pediatric intensive care unit (PICU).
Until recently, a child in the Flathead Valley or surrounding area needing this level of care would usually have to travel great distances, sometimes to Seattle, Salt Lake or Denver, to be treated. For a kid, that means leaving their house, siblings, friends or even one of their parents to receive necessary care.
But now, much of this intensive care can be found right here at home.
Last year the pediatric intensive care unit at Kalispell Regional Medical Center opened, and I am thrilled to be part of this amazing endeavor. I came to Kalispell from New York City, where I had been on staff as a pediatric intensivist at Mount Sinai Hospital for the past 14 years. After many years in the “big city,” I could not pass up the opportunity to help lay the foundation of a new, regional pediatric program with an amazing staff. I moved to Montana in September 2016 and on October 1, the doors to the combined pediatric unit and pediatric intensive care unit opened.
In just one short year, we have cared for more than 700 pediatric patients, 219 of whom required intensive care in the PICU at some point during their hospitalization. Situations that might lead a child to need such advanced care include severe asthma that elevates to respiratory distress and requires mechanical intervention (such as a ventilator), infections leading to sepsis, complications when diabetes is not under control, and severe injuries, particularly those involving the head and brain. In some cases, the child may initially have been stable enough to stay on the pediatric floor, but transfer to the PICU becomes necessary if he or she becomes more critically ill. Also, pediatric patients recovering from a major surgery may need to be cared for in the PICU for several days post-operation.
The pediatric intensive care unit is where the highest level of care can be provided to children – any child from one to two days old up to 18 years old. In the PICU, the young patient is cared for by a team of health care workers specially trained to deal with these critical situations. The nurses in the PICU are highly specialized and are experienced dealing with the diseases and physiologic changes seen in these patients. It is very common that a PICU nurse will look after only one or two patients at a time so that the children get the unique time and attention they need. This is known as a low nurse-to-patient ratio and is fundamental to critical care nursing. In addition to nurses, we also rely heavily on the expertise of respiratory therapists who help run the machines needed to support children with breathing issues. Their tools of the trade include lifesaving treatments such as aerosol medications and chest therapy. The PICU team also includes physical therapists and speech therapists who are committed to supporting the child during the critical illness and especially during recovery. Dietitians and pharmacists are readily available to advise us in our choices for nourishing the children and providing just the right medications at the right doses. And, of course, our social workers are always on hand to help support the patient’s parents and family members, for whom the experience in the PICU can be exhausting, scary and disruptive to their normal lives.
As a pediatric intensivist, it’s my job to oversee the care of all the children in the PICU. This involves making the correct diagnosis and implementing modern therapies. I coordinate the care provided by the PICU team members and work closely with the nurses who are involved in the minute-to-minute care at the bedside. I also may call upon my colleagues for expertise; Flathead Valley is blessed to have experts in many areas of pediatric care including cardiology, gastroenterology, neurology, hematology, endocrinology, psychiatry, surgery, neurosurgery and ophthalmology. It is extraordinary that we have this depth of pediatric subspecialty care right here in the Flathead Valley, and I am honored to work with this committed group of doctors.
It is indeed a pleasure to be here in Kalispell, Montana. I hope that no child or family will ever require my services in the PICU, but I am here to provide the right care at the right time with the right team to any child with a critical illness.
Pediatric specialty care
Montana Perinatal Center providers and staff are pleased and privileged to work with the growing roster of pediatric subspecialists hired in recent years at Kalispell Regional Medical Center. The providers at Montana Perinatal Center are perinatologists, a specialty in obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies, also known as maternal-fetal medicine. Montana Perinatal Center physicians often deliver premature babies, newborns with birth defects or children with other complications. However, expert pediatric care extends beyond delivery at KRMC. Dr. Satchell and her skilled team oversee the pediatric intensive care unit, where they care for babies and children when they need it most. Learn more about maternal-fetal and pediatric services at Kalispell Regional Healthcare at krh.org/children.
First published in Montana Woman magazine, January 2018