Thursday, January 23, 2014

Here We Go 'Round the Mulberry Bush

Well...where do I start...I chose the title of this post based on the fact that Jack is back in the hospital. I could start singing a song using that melody, but it would be very long and very repetitive.

That last part I wrote in the previous post... Yep... That's why we're here. At 3am Wednesday morning Jack started to retch/vomit every 2 minutes. By the morning he was quite weak. We already had a doctor's appointment and I had Katie with me, so I opted to care for Jack at home until he could see his pediatrician. Long story short, Jack retched/vomited bile and dried blood all morning and the doctor planned on doing an IV Bolus (lots of fluids over an hour) but his vein blew on the first try. The local Children's Hospital was called for a direct admit to a bed. There were no rooms available. We drove to the ER (Katie still with me) for a room to get the necessary fluids. Unfortunately, there were no rooms available in the ER for an hour and then once we got back (at this point, Jason had left work and got Evelyn off the bus and came and picked up Katie) it took another hour for xray and labs and assessment before the fluids were started. Jack just kept going downhill until he was severely dehydrated. 

His labs showed a very high white cell count and very low blood sugar. He got a second IV bolus of glucose. He got Zofran (for nausea) through the IV. He was barely awake and extremely weak. However, he was better than I've seen him in the past (gotta try to keep positive). He got a 3rd bolus of general fluids while we waited to find a bed. We were either going to stay locally or be transferred to St. Louis Children's. After a long long wait, a bed was snatched locally and we got a room late last night.

Here's the time frame (this is more for me):
Tuesday 6pm tons of vomit. Lots of mucus. Most likely from cold.
9:15pm tons of vomit. More mucus. Didn't feed anything overnight.
Wednesday 3am retching/vomiting mucus and stomach acid every 2 minutes. Lots of attempts to swallow it back down.
5am still awake with Jack trying to find a way to calm his belly down before he takes a turn for the worse.
7:45am give Zofran tablet to try to calm down belly. It works a little bit. Retching/vomiting spreads out to every 10 minutes. Consistency begins to show bile and dried blood. 
10am contemplating taking Jack to the ER but he has an appointment at 1 that was scheduled for a physical. Have Katie with me. Don't want to bring her to the ER.
12pm kicking myself because Jack is getting worse. Sure do wish I had a babysitter for Katie. Make note to self. Find local babysitter for Katie in near future.
1pm see doctor for Katie's 18month and Jack's physical that changed to sick appointment.
2:30pm attempt to get IV started for bolus fluids. If it doesn't work the first time Jack will be admitted for 23 hour observation. The vein blows and that call is made. End up driving to ER, Katie still being the awesome kid she is! Give her a drink, a snack, and the iPod and she's a happy girl!
3:30pm in the ER. Triage is done right away. No rooms available. 
4:30pm brought back to room. Talk to doctor. He's nervous and uncomfortable with Jack's medical history. I can tell. Nurse wants to take Jack to the potty for urine sample. Uhm...yes. He's 5. No. He wears diapers. Xray comes to get Jack. Assumes he can stand for chest xray. Uhm...he's 5 but he can't stand and even of he could he's way too weak. He can't even sit up. IV eventually put in and on the first time!!!! Blood drawn directly from there! Phew. That saves a step. Bag put over Jack's little winky to collect urine. Zofran given through IV. First bolus of fluids given. After bolus. blood sugar checked. Extremely low. Bolus of glucose given. Talks of admit (duh!) but can't find bed at local children's hospital. Call St. Louis Children's. Begin plans to transfer there. Find out a bed is available but Jack needs to be reassessed first. Might be too ill for local hospital. At this point, I'm like whatever! He's gonna lay and rest wherever he is. He needs fluids and rest. Please just let me now what's going to happen so I can plan. Spikes a fever of 102. Peds Hospitalist comes. Talk for more than 30 minutes. Clouding seen in Jack's right lung. For sure admit here. Needs another bolus of fluids first then up to the room.  Draws more blood from IV before bolus to get blood cultures.
11:45pm finally in the room. Yes. We were in the ER for 8 hours. Doesn't matter where he was as long as he got the fluids and meds he needed. My opinion. Hospitalist tests for flu and schedules another chest xray in the morning. Jack retched/coughed up bile all night, even with zofran. Slept hard this morning.
8am labs drawn from fingers to check electrolytes and probably something else. Jack fought. He's not as sick as last night.
8:30am brought to xray. Jack sat up in the stretcher the entire ride. He sat in a chair for the imagine. By the time we got back on the stretcher he was pooped. 

12:30pm Jack has been resting and sleeping all morning. He coughs a bit every now and then. He vomited bile for the doctor. Good timing. I'm draining his stomach into a special bag so we don't have to pump his stomach. The xray form this morning shows more clouding. 
This means that Jack either aspirated while vomiting/retching/swallowing it back down (yuck!) or has pneumonia. He might have aspiration pneumonia. They aren't for sure yet and radiology hasn't decided or given their report. An antibiotic was started to treat the pneumonia, if that's what it is.

One last thing. In xray, there was a radiology student/nun. She was all in white. The sister looked like an angel. I tear up now and I teared up admiring her. Thank you for the sign. 

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