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PaperclipPerfector  1yr ago (text post)   3206 thread views

Friday Fun Thread for November 17, 2023

Be advised: this thread is not for serious in-depth discussion of weighty topics (we have a link for that), this thread is not for anything Culture War related. This thread is for Fun. You got jokes? Share 'em. You got silly questions? Ask 'em.

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All 3 of them in the ICU? Do they have autoimmune issues? RSV isn't normally that severe.

Actually I have a puzzle if you're interested.

3 year old female presents to the ER with the following symptoms:

  • Fever. High of 104.5, has not gone below 101.3 in five days despite parents alternating Acetaminophen and Ibuprofen every three hours.
  • Lethargy. Does not respond to parents saying name, wakes up when IV line is placed but goes back to sleep, fell asleep standing upright.
  • Lack of appetite. Not drinking fluids, no urination in 24 hours.
  • 40-50 breaths per minute, heart rate is 40-50 bpm (not a typo, and yes she is 3 years old.) O2 is 90-94%

Nasal swab comes back indicating RSV and Parainfluenza. Chest X-Ray is clear, chest sounds clear on stethoscope. No change to vitals after receiving fluids. No post-nasal drip or other symptoms.

She was born at 40+2 (not a premie) and has had no prior medical history.

The patient is admitted to the hospital. The reason given on the admission paperwork is "Dehydration." An EKG reveals nothing unusual. There is no change to her heart rate or temperature even under hospital care. She still sleeps most of the day.

After eight days of admission, her care team runs another test, an MRI of her head, and discover something that changes their treatment. They discover bacterial sinusitis, and treat with antibiotics.

She is discharged to home on day 11.

They think the low heart rate was due to exhaustion. Another theory is that she just has an "athletic heart" whatever that means.

I'm no paediatrician, if you think adults can be finicky, kids quadruply so!

They tolerate with alacrity what might off an adult, and then fall over after a stiff breeze.

At any rate, bacterial sinusitis is usually a secondary infection on top of a viral one, IIRC, likely due to the RSV and parainfluenza. The diagnosis given at the end seems to me like the doctors going "we have no fucking idea what's going on here, but she didn't die on us, so we were doing something right". By athletic heart, they mean the observation that extremely fit people often have resting heart rates below what's consider normal, which is entirely benign or even a sign of excellent cardiovascular health. I have no idea how that's applicable for a toddler, unless you breast-fed her on the really good shit haha, but I have no other diagnosis myself.

There is something I've wondered, but I suspect a doctor in real life would not confirm it because the profession is hard enough as it is. Should they have identified the sinusitis sooner? Might they have identified it sooner if it was not for the weird heart rate serving as a massive red herring?

They only did an MRI because they were concerned that something was going on with her brain that was preventing it from regulating her body temperature and heart rate. (The MRI was also the reason she was in the ICU. The hospital would only perform it on patients that young if they were fully sedated and at that point they were settling in for a long haul of tests and whatever came after.)

RE: Athletic heart, my wife is a cardio bunny and often has a very low resting heart rate. Every time she's connected to a machine, the machine goes off until they just turn the damned thing off. It happens. When I was in better shape around the time I got my 2nd degree black belt, the same thing happened to me.

It's funny because this kid is the biggest lollygagger. She will insist on being carried half way through every walk. She will pause for 15 seconds every time she goes through a choke point (hallway, doorway, any other constricted area) with people behind her. Her response to another kid snatching a toy away from her is to stand there and wail as loud as she can, even if the kid is half her size. So this hypothesis is kinda funny to me, but to the doctors who don't know her maybe it sounds more reasonable.

They had RSV and Parainfluenza simultaneously. I don't know if there is a lot of research into how severe these two are in combination, but my n=3 says it seems to increase severity in small kids.

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