The short explanation is that he was having a severe asthma attack (triggered from a cold or flu). His coughing and harsh breathing caused air to collect between his heart and his pericardium (sac around the heart).
Sunday afternoon, Joshua was wheezing and coughing out of control. I gave him the inhaler every 4 hours. By around 4:15 I gave him another dose and by 4:35 he was just a mess. So I gave him yet another dose on our way out the door. I debated going to the ER or just to Urgent Care. Urgent Care was closer by 20 min at least so we went there.
In Urgent Care the doctor gave him an injection of Solu-Medrol (steroid) at around 5:00. She sent up home with a script for Prednisone (steroid) and Xithromycin (antibiotic) "because sometimes steroids can open us up to infection."
The steroid should have relieved his breathing within 2 hours. He was breathing a little better at first. By around 11:00 he was just gasping for air. It was bad. We went to the ER.
I really like Duke for a couple of reasons. I like that they have a pediatric ER. We were taken back immediately and a pediatric respiratory therapist met us before we even got to an exam room. He gave Joshua 3 back to back nebs of albuterol. This sent his heart rate up pretty high (around 170-180). So they needed to monitor him to be sure his heart rate went down.
The doctor decided to send him for x-rays to rule out pneumonia. What they revealed was Pneumopericardium- air between his heart and the pericardium. It wasn't alot of air, but enough to need to be admitted for observation.
In the night Joshua bounced all over the respiratory globe. His oxygen saturation got as low as 88 (normal people breathe at 99-100) and they talked about putting him on oxygen. Then they gave him another neb of albuterol and his heart rate skyrocketed to 178.
We decided to put him on Xopenex (albuterol replacement that does not effect the heart). This worked fine until the next repiratory therapist came on shift and decided it had been long enough since his triple dose he innitially had and Albuterol should be fine. His heart rate jumped up again and the genious realized, yeah the other docs were right lets keep him on Xopenex.
So anyway, he had more x-rays on Monday evening. These revealed that the Pneumopericardium had not changed. This is good because it is not getting bigger and it will probably resolve itself over time.
They gave us a choice about going home or staying the rest of the night. We decided to go home. Joshua was really missing his brothers and sister. The doctors were very confident with sending him home.
I really like Duke for it's pediatric ER and it's children's hospital. They really go a long way to make kids more comfortable. Joshua had all the apple juice he wanted plus a Playstation in his room. I brought a few comforts from home and he was all set!
It didn't take long for him to decide he didn't like hospital food.
I had the help of some wonderful friends. Thankyou Rosie for watching the other kids for me. Thankyou Donna for filling in for Rosie so she could go to her dentist appt. Thankyou Daniel for sitting with Joshua so I could run home and make sure everyone had what they needed. Thankyou Mr. Dale for visiting with Joshua for so long. Thankyou all for praying for him. It was pretty scary for a while.
Joshua is home now. He is much improved and enjoying being pampered by everyone.
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