Anybody ever seen anything like this??

Specialties NP

Published

Specializes in Urgent Care.

Newish FNP working in urgent care. Last night one of the MAs pulled me out of an exam room for an emergency (I'm the only provider on site). Kiddo maybe 6-8 years old slumped over being carried by dad...we got him into an exam room and kiddo's breathing is super distressed. His fingers and toes are cold so we're struggling to get vitals (we don't have a lot of fancy monitoring stuff) but he's clearly altered, eyes wide open rolling all over the place, not focusing on anyone and only minimally responding to his mother's voice. His lungs are completely clear, no stridor, no apparent obstruction. Just very disorganized breathing pattern. Couldn't get a pulse ox to read so put 2L simple mask on just since he was so distressed. Sent the MA to call an ambulance. Finally pulse ox pops up 100% so I took the mask off to see if he'd maintain but he started to desat right as EMS walked in. They also said his airways weren't obstructed and his lungs were clear. They didn't seem to know either. Scooped the kid up and took him to Children's up the road from us. No *clue* what was wrong with the kiddo. Maybe toxin or medication that he got into? Something neurogical? No fevers but kiddo had been home sick with a cold but his symptoms were very sudden onset (they live near the urgent care and parents had dashed straight to us when he got sick). Anyhow, I'm hoping he did OK...we never even got him registered and I don't think there's any way to follow up. Super scary but also super curious.

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Specializes in CEN, Firefighter/Paramedic.

Afebrile?

We had a case like that a few months ago that we felt was an accidental opiate overdose to the extent that we notified police.

Turned out to be a severe systemic infection.. 

Reach out to Children's for a follow-up, would love to hear the diagnosis..

 

 

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Specializes in Urgent Care.

Yes afebrile. In fact he felt cold. I think that's why I was having such a hard time getting a pulse ox to pick up. Would be curious what his abg looked like. We're frustratingly limited in urgent care! I may try to call but I don't even have a full name on the kiddo. We never even got him checked in. Not sure they'll tell me anything but I may give it a shot. Admit I've sort of been obsessing. 

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Specializes in CEN, Firefighter/Paramedic.
47 minutes ago, Saf1 said:

Yes afebrile. In fact he felt cold. I think that's why I was having such a hard time getting a pulse ox to pick up. Would be curious what his abg looked like. We're frustratingly limited in urgent care! I may try to call but I don't even have a full name on the kiddo. We never even got him checked in. Not sure they'll tell me anything but I may give it a shot. Admit I've sort of been obsessing. 

Very interesting.

 

If you have a decent relationship with the fire/ems department that came, maybe reach out to them first?

 

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Specializes in APRN / Critical Care Neuro.

I saw something similar in a grown man that came into our ED and up to our ICU.  His pH was 7.02 and it was metabolic acidosis, not respiratory driven.  They were thinking it was because he had taken a new prescription of Metformin....but no way it was that without overdose so quickly.  But what you describe sounds like a similar presentation to this man.  He did report having had diarrhea for a few days before, but his kidneys were failing and he was very average to small framed.  The metformin had been started as aggressive measures for "pre-diabetes" at low daily dose.  Nothing that one would expect that kind of severe reaction. He had no prior known medical history and his previous labs should healthy kidneys that were now failing fast. My fear is Ivermectin, especially the over the counter animal version.  It can cause severe diarrhea and I am afraid people are so terrified of COVID they are trying to self medicate inappropriately.  Despite intubating him and starting emergent dialysis which quickly turned into CRRT we lost him.  Still waiting on toxicology labs to understand how and why.  Now I'm afraid it isn't just COVID we are fighting, but the fear, the misinformation and the myriad of ways people can harm themselves and their loved ones. 

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Specializes in Urgent Care.
9 minutes ago, FiremedicMike said:

Very interesting.

 

If you have a decent relationship with the fire/ems department that came, maybe reach out to them first?

 

I mean it's worth a shot. My dad used to be a medic with the same company maybe he knows someone.

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Specializes in APRN / Critical Care Neuro.

https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.13537

Not that it was necessarily Ivermectin, but this link looking at the potential toxicity of different treatments at home for COVID might be useful to you right now.  Problem is that I am not sure people will be forthcoming with exactly what they did or did not do, especially with their kids.  There will be denial and fear of repercussions to deal with as well. 

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Specializes in Urgent Care.

Honestly metabolic acidosis would make a ton of sense with the presentation (compensatory breathing pattern maybe). He'd been sick...it does make me wonder. Ivermectin never even crossed my mind but I do wonder how it might affect a little guy. Or even if it was just run of the mill diarrhea. His lips were super chapped and the mom kept putting chapstick on him. I'm in Southern Colorado it's *dry* here so I didn't think much of it. They came in holding a glass of ice water for him as well...so maybe it was electrolytes or dehydration. Hopefully if it's something along those lines his young kidneys will bounce back. Hmmmm...more things to think about. 

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Specializes in Urgent Care.
2 minutes ago, ZenLover said:

https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.13537

Not that it was necessarily Ivermectin, but this link looking at the potential toxicity of different treatments at home for COVID might be useful to you right now.  Problem is that I am not sure people will be forthcoming with exactly what they did or did not do, especially with their kids.  There will be denial and fear of repercussions to deal with as well. 

I've been stunned at the misinformation my patients have parroted to me, especially around the vaccine. Really appreciate the resource...I'll be on the alert for symptoms of these home "treatments." 

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You did exactly the right thing! Call 911 and get him to Children's! Would a Tylenol overdose cause those symptoms?

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Specializes in Urgent Care.
13 hours ago, 2BS Nurse said:

You did exactly the right thing! Call 911 and get him to Children's! Would a Tylenol overdose cause those symptoms?

I don't *think* so I've only seen one Tylenol od, in an adult, and that seems to be more of an hours to days sort of thing as the liver is damaged. This was very acute. The altered mental status makes me think either opiates, or something metabolic like ZenLover described. But yeah, one of the things I'm learning in urgent care is to know not just my limitations, but the limitations of my setting. It's humbling indeed.

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Dehydration

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