Published Mar 1, 2004
What would your ER do about a 13 year old child brought in to the ER for difficulty breathing, but the episode is over before she can get to the ER? My daughter has recently started having episodes where she says she can't breathe. She has discomfort in her upper chest and throat when this happens and she doesn't feel like she can get a good breath. Our PCP has her scheduled for an asthma nurse appointment and a thyroid ultrasound (in case it is enlarged and putting pressure on her upper airway) but these appointments are two and three weeks down the road. The NP in the office said to take her to the ER if it happens again. Well, it happens every evening sometimes three or four times a night, sometimes just once a night. She put her on a Floradil aerolizer, but no "rescue inhaler". We live about 20-25 minutes from an ER and these episodes last about 5-20 minutes. I started to take her one night, but by the time we got about half way there, it was over. I called the on-call nurse for our PCP and since the acute episode was over and she seemed better, she told me to just watch her.
Five minutes after these episodes she seems normal. It is very distressing watching her during one of these episodes and, of course, I am always thinking about what if it doesn't stop this time. I don't work in an ER, but I know what some ER nurses and physicians think of parents who bring in "healthy kids". What, if anything would your ER do if you got my child in your ER after one of these episodes had passed?
Our PCP treats me like I am over-reacting to this, but he has never witnessed any of these episodes and I just can't seem to convey to him how scarey these episodes are.
is she hyperventilating or is she wheezing, with labored breathing and stridor?
Do any of these events start when she is upset or nervous or around cigarette smoke? Has she ever been around a dr when she had an attack like this?
Are you a nurse? Can you check her pulse and respiratory rates during an attack? Can you listen to her lungs with a stethoscope? What happens before the attack? And how does the attack end? (I mean, can you calm her breathing by talking with her or does having the air conditioner in the car on help, whatever...)
I'm certainly not a doc, but it's been my experience that acute asthma attacks don't end spontaneously - they usually need some kind of intervention with medications (by nebulizer or whatever). Other things can cause difficulty breathing, and having some kind of physical obstruction could certainly be one. Does some sort of activity or movement start this all off?
Does this seem to be related to any food, medication, contact with anything (the cat or dog, chemicals, feather bed, whatever...)?
I forgot how old your daughter is, but is she in puberty? Those pesky hormones can sometimes cause anxiety leading to hyperventilation. So can anxiety about other things (school, boys, friends...). Could she be anemic?
I would advise you to stay as calm as possible when these occur while trying to observe as much as you can (make a note so you can remember the specifics to tell the doc). Don't hesitate to go the the ER or call 911 if she is in acute distress.
Here's a great pediatric site: http://www.med.umich.edu/1libr/pa/pa_index.htm
traumaRUs, MSN, APRN
The above poster gave good advice. I'm an ER RN and I've never seen asthma spontaneously resolve w/o interventions. As to airway obstruction - that can come and go! So can stridor. Good luck...
if you can listen to her...it would help to figure out what's going on....
here are some ideas that are common and can occur just like you stated...
anxiety attack (at times brought on by absolutely nothing...)
reflux (in children can cause resp distress esp at nite while supine.)
i guess to answer your initial question,
"What would your ER do about a 13 year old child brought in to the ER for difficulty breathing, but the episode is over before she can get to the ER?"
chest x-ray, pulse oximetry, pediatric ekg, cbcd, sma7, and possibly abg. if everything was negative, do what your pcp has already scheduled. go home with a rx for prelone and albuterol.
it seems the episode resolves when you are enroute to the er, correct? if so, do you transport with the windows down (just curious), b/c if you do, the humidified air may help resolve the episodes as with the croup.
I have been putting her in a steamy bathroom. I have only actually tried to take her to the ER twice, but both times it stopped before we could get very far. Now I just take her into the bathroom and turn on the hot shower. And watch.
If it is a panic attack, I can't find a cause for it. The only pattern to them has been that they seem to happen in the evening. I wondered if maybe something hormonal was triggering it.
I think I forgot to include in my original post that on a Saturday and Sunday nights she had these episodes and then the following Monday morning woke up with a sore throat, nasal congestion and a fever. She said these episodes had happened "about five times" since last Fall, but she did not tell me about them until that Sunday night.
The doctor thinks this infection is exacerbating whatever the underlying problem is.
Sorry I don't have time to address all of the questions right now, but I really appreciate all of the replies. I was really wondering about what if next time I just took her to the ER regardless of if the event was still occurring when we got there. It sounds like they do quite a work-up. I just want to find out whatever it is so we can get it treated.
teeituptom, BSN, RN
have you thought of a behavioral counselor
maybe there is something going on you are not aware of
and at 13 I know from raising 2 daughters that is a very tough time for them and for you all too.
I'm not in pediatrics at all, but what you described reminded me of when my kids came down with croup. It always happened at night, and it sounds horrible, but all it took was us taking them outside for a while to help clear it up. In fact, when we did take our son to the ER once, he was fine about halfway there, and the ER doc told us that that usually happens (the night air seems to help). They were always fine during the day, no sign of illness, it would just pop up at night. Sometimes they had cold s/s afterwards, sometimes not. I don't know if teens can come down with this, or if it's mainly young kids, but I thought I'd let you know. Good luck!
actally what you added...it does sound like croup...the going outside into the cool air may be breaking it....the runnynose/sore throat fits...
they used to say older kids didn't get croup...not true...more and more -older and older kids are getting it...i have actually have had to tube an 8 and 9 y/o due to none other than croup.
The symptoms you report are highly suggestive of anxiety/hyperventilation syndrome. However, croup (which was mentioned in prior posts as now being seen more frequently in older children) cannot be ruled out. As suggested in some earlier posts - it would be interesting to know her respiratory rate during these episodes as well as auscultated lung sounds. Have you observed any carpo-pedal spasm? Any complaints of tingling or numbness of her lips? Keep us posted and good luck.
but thats unusual in the grander scope of things
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