On Labor Day, Clara took her first, and hopefully last, ambulance ride, lights and siren included.
Our intent was to spend an extended labor day weekend relaxing and visiting with family in northeast Ohio. After our family trip to the dentist Friday morning - cleanings for Ellen and Owen, an attempted cleaning for Clara, and a root canal for me - we loaded up for our road trip. When we arrived at Grammy and Grandpa's house, Clara had a runny nose. The kids have been back at school for a couple of weeks so it was not surprising that Clara would be getting a cold.
The runny nose continued on Saturday and Sunday, with the addition of a mild cough. With the exception of sleeping poorly at night, Clara was playing, eating, and napping normally. Throughout Sunday night, Clara's breathing became more labored and she was having difficulty sleeping. She was restless and was only staying asleep for short burst before startling awake.
In the past, when Clara has had difficulty breathing associated with a cold, we have given a couple of puffs of albutirol from an inhaler that was prescribed when she had bronchiolitis when she was six months old. We had discussed this treatment approach with her pediatrician and received acknowledgement that the approach was appropriate. Since we rarely had to use the inhaler and Clara did not start with the runny nose until after we left the house, we did not have the inhaler with us.
On Monday morning, Clara was running a fever and was visibly having difficulty breathing; however she was alert and sat with us to eat some eggs and drink some juice. Since we did not have the inhaler and Clara was running a fever, we decided to take Clara to urgent care thinking that she would have a breathing treatment and that we would go on with our plans for the day. After waiting for two hours, Clara was called back and hooked up to a pulse-ox meter. The meter indicated that her oxygen saturation was 71 percent. Since Clara was not exhibiting symptoms typical of reading that low (e.g., blue coloration), the nurse used another meter based on the assumption that the first meter was not accurate. The second meter provided the same reading; therefore, Clara was connected to a supplemental oxygen supply and given an albutirol nebulizer treatment. Following the treatment, her oxygen saturation only increased to 76 percent with the supplemental oxygen and her heart rate increased to 200 beats per minute; therefore, an ambulance was called to transport her to the emergency room.
Following some discussion between the urgent care physician, the ambulance medics, and Ellen, a decision was made to transport Clara to the emergency room at Akron Children's Hospital. Supplemental oxygen continued to be provided via nasal cannula, which Clara ripped of at least half a dozen times. Additional albutirol nebulizer treatments were also conducted. Once she was stable, a chest x-ray was taken which ruled out pneumonia but indicated that Clara's lungs were hyperinflted. The ER physician indicated that Clara was likely hazing an asthma attack and that her lungs were hyperinflated because ahe was not able to effectively move air out of her lungs. Based on this information, Clara was given an oral dose of steroids (fun experience with an already ticked off, strong, extremely flexible two-year old) and a dose of magnesium through an IV.
After almost four hours in the ER, Clara was admitted to the pediatric intensive care unit because her oxygen saturation had been so low and her heart rate had been so high. Although she was exhausted, she was not happy about being wired up and confined. Throughout the night, they were able to slowly reduce the supplemental oxygen without negatively impacting Clara's oxygen saturation. Clara is a restless sleeper and tosses and turns throughout the night. Tossing and turning does not work well with multiple wires and hoses, so Ellen and/or I were awake often trying to make sure that Clara did not end up with cords tangled around Clara.
On Tuesday morning, Clara was transferred to the general care floor. While awake, her oxygen levels were good and stable, even without the supplemental oxygen. However, when she was sleeping, her saturation levels would drop below the specified range if she was not attached to supplemental oxygen. Since she had ripped the nasal cannula off so many time previously, we decided to leave it attached rather than removing it and reconnecting it for nighttime monitoring. However, Clara was allowed to walk the halls and to get on the floor and play. During her walks, she decided that she needed to visit any patient with an open door to say hi. Anyone walking the halls also got a bright and cheery hi!
Happily, Clara made it through Tuesday night without the need for supplemental oxygen. She was disconnected from all tubes and wires and had freedom to roam and play. If her room door was open, she wanted to be out in the hall and visiting the other patients. Let's just say that it is hard to resist a cute two year old giving you a bright and cheery hi accompanied by an equally cute wave.
As we were packing up and waiting for the discharge papers, Clara was sitting on the floors with two of her dolls having a little conversation. During the course of her conversation, she would occasionally point to the door of the room and utter a clear and excited bye-bye accompanied with her cute bye-bye wave, as if she was explaining to her dolls that they were all getting out soon.
While I hope to never have another emergency experience with our kids, I am glad that we are now aware that Clara has asthma. We are prepared to deal with asthma occurrences before they become dangerous and we can coordinate her regular medical care with appropriate medical professionals. Others that care for Clara in our absence will be aware of her condition and will be equipped to provide care in the event of an attack.