Wednesday, December 14, 2011

My 3 YO daughter's second asthma attack

So my reserved 3 YO daughter was fine when I came home from work last night, yet right around bed time she started coughing, retracting and with my stethoscope I heart inspiratory and experiatory wheezes.  She was tight and her words were short and choppy. 

I gave her a treatment.  It benefited her, yet she was still tight with wheezes.  I had a distinct feeling it was going to be a long night.  An hour later she was distinctly bad again and I gave another treatment.  She fell asleep in my arms, and when I set her in bed he head bobbed up and down on the pillow from her bodies effort to suck in air. 

Remembering my experience sitting up all night suffering from asthma and my parents not realizing what it was, I didn't want my daughter to go through the same thing.  So I didn't think I'd fall asleep.  Yet I must have.  At 11:30 I was awake and heard no coughing.  For a moment I though we had made the right decision not to go to the ER.  Yet then the coughing started.  Then...

"Mommy and Daddy," she yelled in a panicked voice.  I picked her up and she was unhappy I was around.  She was agitated.  She didn't know what she wanted.  She was retracting and audibly wheezing.  It was an easy call.  My wife got out of bed, snuggled our daughter in the recliner, and we made the decision it was time to go in for another steroid shot.

This time one of our regular doctors was working.  She was great. Here's what she charted:
child tends to have wheezing and over the past few weeks has been wheezing more frequently and was on oral steroids at one point.  over the past 2 nights she has been wheezing to the point of requiring breathing txs at home.  tonight she took pulmicort for the first time and this seemed to make the wheezing worse.  mom brought in for further eval. due to her sob.  dad has a hx of severe asthma and is a resp therapist at the hospital here. FREQUENT NONPRODUCTIVE COUGH, DIFFICULTY BREATHING.  Seen by pediatrician earlier in day for same reason.  active/playful/smiles, age appropriate attention, good eye contact, no apparent distress, not irritable, not lethargic Temperature: 98.6, Heart Rate: 140, Respiratory Rate: 48, Pulse Oximetry: 97, Weight: 28 (unable to get vitals previous visit).  x-ray normal.  child given 2 xopenex nebs upon arrival and decadron im.  after third neb child was much improved.  she had a p ox of 97% on ra and was talking well.  retractions were gone.  will give prelone for home and discussed close follow up.  scripts:  Prednisolone (Prelone) 15 Mg/5 Ml Syp  25 Mg OR DAILY (note:  Errors are the doctors.  I did not correct grammatical errors).
This doctor is one of our regulars and she also has kids, so that helped a great deal.  My daughter must have sensed she was a good person, because she actually let her assess her.  This just goes to show that if you're good in your approach you can even get the most reserved kids to cooperate in the ER.  Common sense, you know, goes a long way.

The doctor also said that decadron has a tendency to last longer than solumedrol, sometimes up to three days.  She said that's why she prefers to use it with kids, especially kids who don't like to take nasty taking prednisone pills. 

At 3 a.m. my wife arrived home and she went to bed while I stayed up with my sweety.  HM was hyped up from all the medicine and was marching around the living room chanting a hundred words a minute.  Finally she asked me if I'd lay down with her, and before my head hit the pillow next to hers she was sound asleep. 

Today she was back to normal.  This was a much better ER experience than three weeks ago.  It shows how smooth things can go when you respect the parent.  Or, it shows how smooth things can go when the parents and doctor use common sense.

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