Friday, September 28, 2007

Intensive (S)Care- a bronchiolitis story

Since patrick has been going to daycare, he has brought home every lurgy going round. He's has a constantly snotty nose for over a month now, as well as coughs and conjunctivitis. I'd like to point out I'm not against daycare, it has been a godsend for us and considering the workers get paid less than I did for being a hospital cleaner 17 years ago, they do a bloody hard job for very little recompense.

So Patrick had been off sick with his conjunctivitis since last wednesday. On Monday I stayed home from work and looked after him- he was ok but a little sleepy. On Tuesday he had a cough and MrT looked after him. On wednesday we decided to take him to the doctor, as he had been sick for a while. I was working from 0700 to 2100, and MrT took him to the after hours service. He had red eardrums so they gave him some ibuprofen and some antibiotics.

But by the time I got home at about 2200 he was worse. Much worse. He was lethargic and clingy, had a resp rate of 80 and wasn't interested in boob at all. Then we noticed his tracheal tug, and his subcostal recession. Finally, MrT said "Does he look a little... blue... around the lips there?". He was.

So we took him off to the local Emergency Department where we were swiftly seen and taken to resus. He was shut down, tachycardic at 200bpm, and saturating at 80% on room air. He didn't even protest much when the put a cannula in. We were reviewed by ICU and then I had the surreal experience of sitting on a bed being wheeled upstairs to ICU. I have accompanied plenty of patients on that journey myself, so it was very, very odd. The staff (who know us both very well- MrT worked there all last year and I have worked there on and off for many years) welcomed us in and gave us heaps of hugs.

Luckily he escaped needing CPAP. By the morning, his subcostal recession had eased, and he wasn't quite as hypoxic, although he still desaturated- to the 70's- when he pulled his oxygen off. He was discharged to the Paed ward fro continuous spo2 monitoring and oxygen. By this morning, he was doing much better and they turned off his oxygen and capped his drip. By this afternoon, he had picked right up, and was satting at 90-94% on room air, and was ok for discharge.

So tonight he's home. The usual course of bronchiolitis is that it gets worse over 48 hours and then improves rapidly, so the expectation is that he is on the up and up. In case you're wondering, the evidence is that unless there are chronic lung or heart problems, it is ok to be discharged with sats 90-92%.

I'm horrified to think just how badly things could have gone. If we hadn't had some medical training, we could well have thought that he just had red ears and put him to bed. What could have happened then doesn't bear thinking about. He would have been hypoxic in bed, away from us. He could have apnoead (stopped breathing) because of his hypoxia. He could have got hypoxic and his heart could have slowed, or stopped.

Put basically, he could have died. Not at a far stretch of the imagination, but a horrible reality.

I don't blame the after hours doctor, either. We know her and she is a competent, lovely physician. Patrick simply deteriorated quickly.

What is the lesson?

Please, if you think your baby is not at all well, get help. Things to look for include-
a fast breathing rate
blueness
lethargy/apathy/floppiness
not wanting to feed
less wet nappies
stomach sucking in under the ribs when the baby breathes
the windpipe being 'sucked in' to the chest when they breathe.
but this is by no means an exhaustive list.

When I think what we went through with all the miscarriages, I sincerely think I would die of grief if Patrick died.
In intensive care. There's a baby in there.
Feeling much better and playing with my toys.

2 Comments:

Anonymous J-Le said...

oh my goodness. i am so relieved to hear he is ok. take good care of yourselves - that's quite an ordeal to recover from.

28/9/07 03:52  
Blogger Mermaidgrrrl said...

Bastard blogger just ate my comment! Take two...

Look at your poor little guy with an armboard. Reading your post brought tears to my eyes - I don't know how parents go on after losing a child. I'm so glad that things didn't go any worse than they did. Things like this happening are why I'm too scared to put Seth's cot in his nursery away from us! Big hugs to you all for going through such a dreadful thing.

28/9/07 20:10  

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