CROUP

WARNING: This is a long one...

Not to mention over 2 months late...I'm trying to catch up I promise:)

Welllll, our stay in California did not end like we planned. We were going to be flying out Monday morning Oct. 1....but Peyton had other things in mind. He had been running a fever since Saturday night but no other symptoms really. He had some wheezing and a cough by Sunday night but just when we was playing hard. Clearly by midnight I knew it was something more.

You will never forget the sound of a croup cough once you hear it. It sounds like an awful barking seal has left the zoo and landed in your home. Greaaat. You also will never forget the sound of stridor once you hear that as well. It is an awful high pitched sound that is made when one breaths in...the airway is restricted and it makes an awful, scary high pitched sound. Stridor usually comes hand in hand with croup and Mr. Peyton had both. He was sleeping OK, so we just let him sleep.

2 AM was a different story. He woke himself up in a coughing fit and then the stridor really kicked in. Croup is worse at night...often clearing up once daylight comes, only to return again at night. He was breathing a bit hard and scaring himself some so I got him out of bed and took him to the kitchen. I opened the freezer door and let him breath in the cold air. Usually the best at home treatment of croup is going outside in the cool air (which CA does not have...not cold enough and too dry), opening the freezer door or steaming up the bathroom with hot water and breathing in the warm moist air. The freezer did the trick and he calmed down and fell back asleep.

I began making further plans in my head in case this got worse. I really thought we would make it until morning. I called my friends in the Peds ICU at CHOC where I used to work. I wanted to know where the nearest kid friendly ER was...just in case. We were a good 45 minutes from CHOC...much too far to drive a child with breathing difficulties. The next nearest children's hospital, Loma Linda, was about 25 minuets...still too far. I wanted a game plan just in case. I googled the nearest community ER knowing they could provide care and transfer us if we needed peds specific care. I put Peyton back to be and woke Chris up to let him know what was going on.

I didn't sleep long. By 3 am the sound of his stridor woke ME up. I could not for the life of me figure out how he was getting enough oxygen. I lifted up his shirt and he was retracting so bad you could see all his ribs, his stomach was sucking in and the area around is collar bone was sinking in...it scared me! In all the commotion Parker woke up and now we had two freaked out 2 year olds. We got Peyton to the freezer again but he was so freaked out and the stridor and cough so bad he didn't look like he was getting any air. The noise alone would scare anyone and the site of him struggling to breath made me want to cry. I have seen plenty of kids in respiratory distress and he had me scared. Along with the stridor I heard wheezing, all without a stethoscope and knew he needed a breathing treatment. Thankfully the friends we were staying with had a nebulizer and Albuterol. Poor Kim, I frantically woke her up and had her get me the med and nebulizer. I got about 1/2 a breathing treatment in him and realized he was going to need some steroids and racemic epi...only to be gotten in the ER. I knew he was in bad shape when he didn't fight the breathing treatment. Poor Parker was laying down on the kitchen floor with his blanket just watching us. He knew something was wrong with his brother and would not leave him to go back to bed. I quickly grabbed my purse and we threw Peyton in the car. I got down the street and was having second thoughts about driving him to the ER...maybe we should have called an ambulance. He was still struggling and coughing...I prayed we would make it to the ER fast and that it wouldn't be busy.

We made it there in less than 10 minutes...it should have taken 15-20 minutes...I however, was flying. We walked in the ER door, they took one look at us and took us right back. They did have a peds section to the ER but no peds specific providers. The ER doc was wonderful as was the respiratory therapists. The nurses...well lets just say they were not peds oriented at all. Trauma maybe...peds, nope. The cussing during the placement of his IV was my first clue. Of course a scared 2 year old is not going to lie still while STRANGERS poke him with a NEEDLE. If it wasn't for the maturity of an adult...we wouldn't lie there either...some don't. I was happy the racemic epi breathing treatments were working and hoped the shots of steroids would kick in. Usually this is all it takes and you are on your way home. I had even called Chris to tell him that I didn't think we would be flying home that day but that maybe he and Parker could head home. Soon after that he began needing the breathing treatments more frequently and started struggling to breath again. He seemed to be having a rebound effect after the Racemic Epi breathing treatments. Initially they would help and then he would be worse off...so frustrating and scary. There came a moment when he was slumped over in bed, too tired to do anything but try to breath. He wanted nothing to drink, did not want me to hold him and would not even cry or answer me. His breathing rate was in the 60's and his oxygen levels were dipping down to 88-89%. This was much to high breathing for a 2 year old and normal oxygen levels are 98-100%. I pressed the nurse call button...and NOTHING. No one was coming. I poked my head out the door and not a soul in sight. I couldn't leave him.... Finally another nurse walked in and looked at him and said she thought he needed some oxygen. Gee, really? Maybe a visit from the respiratory therapist would be nice too. Obviously she was not impressed with his lack of normal breathing because she never came back with the oxygen mask she offered. I quite frankly thought he needed more than a mask. His nurse later walked in and I told him I thought he was struggling a bit more to breath and his oxygen levels were dropping at times. He stood and looked at the monitor and watched Peyton sleep...I guess he thought since he was sleeping he was OK...uh, maybe he is sleeping b/c he has worn himself out TRYING TO BREATH. I did not think it would take a "peds" nurse to figure out this kid was struggling. Maybe I've been in the peds field too many years and it is natural to me....but I really think any mom out there would realize something was NOT right. It would have taken me less than 10 seconds as a peds nurse to walk in the room and realize things were NOT OK and to call a respiratory therapist. I finally asked the nurse to call a RT and he said he would. Time was ticking away and things were not getting better. No RT was coming and I was on the verge of tears and panic. Mom mode was setting in and I was scared. I began thinking am I going to have to switch to nurse mode...I had seen way to many kids go "down hill" and fast. I guess I knew too much at this point and I was thinking of the worse. FINALLY the RT walked in and took one look at Peyton and began to move fast....I lost it at this point and broke into tears. Someone was helping my son and my gut feeling had been right. It was too close to a bad situation for my liking. The RT was WONDERFUL and jumped into action fast. She called to Dr. and began treating Peyton. I told her I was scared of the nursing care he was getting and that they were not taking his situation seriously. I am sure they are good nurses but I did not feel they were peds friendly or assertive enough. The Dr. walked in and promptly told us we were not going anywhere and that he was calling for a transport team to take us to a children's hospital. Music to my ears! There were 2 children's hospitals to choose from and I quickly asked for CHOC. Having worked there for 3 years I knew he would be in GREAT hands. I knew a lot of the transport team and felt very good they would take great care of him. I could sit back and be a mom.

I always wondered how I would handle my own kids being sick after working with really sick kids all these years. It's funny how you fall into mom mode first. Once you come to grips that your child is sick, then you begin to let your nursing knowledge filter in. I tend to let things ride a little longer before calling our Dr. b/c I feel OK treating things at home first. Usually by the time I call the Dr. I know they need to be seen. This illness with Peyton REALLY SCARED me b/c this was the stuff I saw IN the hospital, not at home. I knew enough to realize he could go down hill fast and yet I was at home without my "safety zone" of support equipment. A very scary moment when you see your kid struggling to breath, not getting any air in and yet knowing just what he needs...just not having it! It's knowing too much and automatically thinking the worst. Working in Peds ICU you prepare for the worst so if it does happen you already have things ready to go and in your head have already thought about the steps you will take. Its critical thinking and helps in an emergency for things to run smoothly. However, it is very scary when it is your child and you are thinking of these steps but yet can't do ANYTHING b/c you are at HOME. Panic was an understatement that night standing in the kitchen trying to decide how to help him. Panic was in the ER when I felt the nurses were not seeing what I was seeing. There is something to be said for pediatric trained health care providers and hospitals. I always took it for granted b/c I have always worked with peds trained health care providers and in children's hospitals...now I understand the need for them. Children are NOT little adults. They give little warning before getting really sick, really fast. Thankfully in the community ER we went to the Dr. and Respiratory therapist were WONDERFUL. They gave us the care we needed and were smart enough to realize when we needed something they could not offer. All this to say, be proactive for your child. As a nurse we always say "parent's know their child best". We always listen to the parents. If they ever say "something is not right with my child"....they are right more times than not.

I have never been so relieved as I was when the CHOC transport team walked through the doors. 4 pediatric trained providers to safely get my child the treatment he needed. I knew 2 of the people and was more than happy to hand Peyton over to them. They let us put all the medical equipment on him so it would not freak him out. They let Chris buckle him in the car seat on the stretcher and gave him a bear to hold for the ride. He did not freak out once!

Sadly we did not have our camera near by to capture his first ambulance ride. Parker was quite excited to see the ambulance and wanted to "get in" with "Pey Pey". Peyton was a bit too sick to enjoy all the fuss and to even realize the ambulance was there. Not sure how it would have sounded if I had said, "Can you pause just a moment before you put my child struggling to breath in your ambulance while I take a picture?".... I did remember at the last minute that I could use my camera phone but they already had Peyton tucked safely inside.

Peyton's ride to CHOC. He was tucked away safely inside before I grabbed this shot with my camera phone.
Asleep in his room at CHOC. Obviously rides in an ambulance can wear you out!

Parker checking on "brough". He was NOT happy to leave "Pey Pey" at the hospital. Parker was FINE when I left the hospital with him to go back to our friend's house about 45 minutes away. We were sitting in good ole CA traffic and I had just gotten off the phone with a friend saying things could be much worse...at least they are not puking! NEVER, NEVER say this...not 5 minutes later Parker threw up ALL over the car. Thank goodness it was a rental. We were stuck in traffic and I could not pull over. Oh, the smell. He kept saying "all done" and "gross"! Yes baby it is gross and I too am all done. Not having slept the night before I broke down in tears wondering how I was going to do this. I just wanted to be home and I wanted my mom! By the time we got to our friend's home his fever was 104 and he was starting to wheeze. Great! Thankfully we went to bed at 6pm and he did OK through the night. Lots of stridor and barky coughing but he did not have trouble breathing like Peyton did.

Chris called the next morning to say that Peyton had a really rough night and was not any better. The breathing treatments and steroids were not working. The x rays and CT scan of his neck showed quite a bit of soft tissue swelling, thus pressing on his airway. I knew this meant only one thing. They were sending him to the PICU. I felt OK b/c I knew all the Dr's and nurses there, this is where I had worked for 3 years. He would be in great hands. Our old pediatrician had seen Peyton's name on his list when he made rounds that morning and stopped in to see him. Thankfully he agreed to see Parker in his office later that morning. All it took was being in the same room as Parker to hear his stridor...after seeing Peyton's condition at the hospital he gave me some oral steroids for Parker to try to ward off it getting any worse. Thankfully it worked and Parker never got any worse. We were ready for a break! Off to the hospital we headed so I could trade places with Chris. He needed a shower, clean clothes, food and some sleep. I was anxious to see Peyton in the ICU and also to see my old friends.

Insert Dad/Husband of the year award here. Both times that we have had a child in the hospital overnight for multiple nights Chris has been the one to stay. It has allowed me to go home both times to care for our other child and to get the much needed sleep that you do not get in a hospital. I take most of the day shifts at the hospital and he takes the nights. I could not ask for more!

This is how I found Peyton in the PICU...does not look like an ICU patient to me:) Sitting in bed playing with toys. What a relief. It seems rolling through the doors of the ICU was all he needed to turn the corner. The Docs were waiting to put in a breathing tube and this is what they found! Obviously the steroids had kicked in and his airway was more stable. They watched him for 8 hours and then sent him back to the general peds floor. He went home the next morning!

My favorite pic from his hospital stay! ALL he would eat was chocolate pudding with whipped cream. At that point it was whatever would keep him quiet and food in his belly. The more upset he got the worse his stridor and breathing were...so it was whatever he wanted. I think he was living it up b/c he quickly learned there were not many consequences for his behavior as we did not want him upset. This took a good 2 weeks to break!

Peyton was discharged from the hospital that Wednesday. Chris and Parker flew home that day. Peyton and I stayed one day longer to make sure he was strong enough and well enough to fly. The dry air in the plane could make the croup worse. Thankfully, we were all back in GA by that Thursday, several days behind schedule.

"Thank You" is not enough to cover all Brad and Kim did for us. I am sure we overstayed our welcome by many days. 4 sick kids in a house being remodeled would be enough to drive the sanity from many of us. Now that all is said and done...we are all well and their remodeled kitchen looks fabulous!