Troubles with MRSA, - Ellie's Hospitalization

This post is the second part of this post: http://boultons.blogspot.com/2012/01/troubles-with-mrsa.html

CAUTION! This post is not for the faint of heart.

We got up to the ER, and luckily they weren't too busy. It was pretty uncomfortable for me, because I was carrying Ellie (of course very carefully so I didn't hold her in the wrong place), and I had my purse and diaper bag. I had brought a lot of stuff, since I kind of knew that after the doctor's appointment we wouldn't be heading back home. It was now almost 1 PM, and I hadn't had anything to eat yet. Ellie hadn't eaten much that day either, and was finally wanting a bottle, but they wouldn't let me give her one in case she needed to have surgery for the infection. Even though the ER was fairly empty, nothing goes quickly in an ER. We checked in and sat in the waiting room for a while. We were brought back to a triage room where I gave a history and she had her vitals taken. We were moved to another room, where we waited some more. A nurse came in, took another history and left. We waited more. A nurse practitioner came in and took another history and left. We waited some more. A doctor came in and took another history and left. We waited some more. The head ER doctor came in and took another history and left. We waited some more. Finally the doctor and nurse practitioner came in and we discussed a treatment plan. The doctor thought her wound would need incision and drainage. That meant that she would be given a sedative. They wanted to give her antibiotics and admit her to the Rapid Treatment Unit (RTU) for the night. The RTU is for stays of less than 36 hours, and they thought that she would be able to go home the next morning or afternoon. The doctor and nurse practitioner left and we waited some more.

The nurse came back with a tech and they started prepping her. She had not had a dose of tylenol for a while, so they took her temperature, and it was 102 degrees. They gave her another dose, and started an IV. They had a hard time getting an IV in. She is pretty chubby, and her veins are pretty small and deep. They put hot packs on her little hands for a while to try and pull the veins closer to the surface.

However, they still had a pretty hard time getting the IV in. Once they stuck her, it took about 5 minutes before they had the vein. They just kept digging around in her hand. I was shocked, because that has happened to me before and it is so painful. But Ellie didn't even react. That is how I knew how sick she was.

Luckily she just slept most of the time we waited. Finally around 4 PM they were ready to start the "surgery". They did it right in the ER room. They laid her on the gurney, and had me sit on the gurney on her left. There was a technician that was above her head, who held an oxygen mask over her face. His job was to watch her respirations. She had a stuffed doggie that she had been clinging to all day. He needed to take it away from her so he could watch her breathe, and when he pulled it away, she wouldn't let go and started crying. The doctor sat next to her on her right, and the nurse was by the doctor. They gave her a sedative, ketamine. It doesn't totally knock her out, but they said "she won't remember anything". Once that started to kick in, they gave her some morphine. It was kind of scary to see her under the ketamine. Her eyes stayed open the whole time, and they would wiggle up and down. She had her mouth wide open and her tongue stuck out and would wiggle, too. All normal effects of the sedative, but still hard to watch. Once they thought she was ready, they made the incision. The doctor started to drain it, and she arched her back and cried out. They decided to give her more morphine. The entire procedure took about 15-20 minutes, but it felt like forever. Once they cut her open, they used a tool that looked like scissors to dig around and find all the pus pockets. When they would find one, an amber colored fluid would just pour out of her wound. The wound was then packed with gauze, her diaper was replaced, and we waited some more until they found us a room in the RTU.

It was about 5:00 PM when we finally got into a room. Ellie was coming out of the sedation and was pretty cranky. We went through another round of histories with the new staff. I was so happy when Jeremy made it up with Olivia. I could finally eat, go to the bathroom, and just sit without holding her. Ellie was still in incredible pain. She got tylenol and motrin to manage the pain, and would have antibiotics administered through her IV every 6 hours. They had to come in every 3 hours to put some saline into her IV so that the IV wouldn't clog. Knowing that they would be in so often to give her medicine and such, I thought that it would be a long night, as I couldn't imagine she would sleep through it. Luckily, once she went down for the night, she actually slept ALL NIGHT. Even with them coming in and giving her meds every three hours.

Wednesday was a hard day for her, though. She was still in a lot of pain, wanted to be held all the time, and was refusing to drink anything. I noticed that she was getting some white patches on her tongue, so I called in the doctor, and she diagnosed her with thrush. We started her on oral medicine for that. The doctor told me that she wouldn't be going home that day - they said that the bloodwork they had done in the ER had come back and that her infection was "fairly impressive". They were monitoring her C-reactive protein levels. Your CRP rises in response to inflammation, and is therefore a marker of infection. Ellie's CRP was 25. Technically, it should be zero, but normal levels are considered under 6. So hers was 5 times what it should be. They started her on a saline drip, since she was still refusing to eat. The doctor also outlined the inflammation on Ellie's groin so we could monitor how quickly the swelling and inflammation was going down. Wednesday was a rough day. Diaper changes were painful for Ellie, her bandages kept being taken off so that doctors could look at the wound. She was able to start sitting on her own though, and even stared to crawl around a little in her crib.

That evening, as we were changing her diaper, I noticed that the redness was spreading down her leg, past where the doctor had marked. I called the nurse who called the doctor, and after some conversations, they decided that they needed to transfer her to another unit that had a capacity to deal with a more complicated infection. So we packed up and moved again! We got a new round of nurses and doctors, so that meant another round of histories! The good news, though, is that we got private rooms everywhere we went. Although the culture results weren't back, the doctors thought that the infection was potentially due to MRSA, so they wanted to keep Ellie isolated. By the time we were in our new room and talking to the doctors, Ellie's leg already looked better. We were hopeful that after another night, things would be better in the morning. Ellie was still on saline because she was still refusing to drink anything.

Luckily, Ellie had another good night, and slept through the night. By Thursday morning, the swelling and inflammation was looking a lot better. The doctors were hoping to send her home sometime that day, as long as she would start to drink on her own. They wanted to send her home on antibiotics. She was getting clindamycin through her IV, so they wanted to try it orally. Apparently, clindamycin tastes horrible, and many kids can't tolerate it. Ellie hated it, but I was so proud that she got it down. Until about 30 seconds later, when she threw it all up. After that, they started talking about discharging her with a PICC (peripherally inserted central catheter) line, so that she could get IV antibiotics from home. A PICC line is inserted into a vein, typically in the upper arm, and is a long tube the goes all the way up to the heart. I was really hoping for another solution, because I did not want her home on a PICC line. After much discussion, the doctors decided to send her home on a different oral antibiotic, one we knew that she could take orally. I would just need to watch her to make sure that the infection wasn't coming back. As Ellie had finally started to drink on her own, we started the discharge process early that evening. One final step was a visit from the wound care team. They would change Ellie's dressing and re-pack the wound and show me how to do it so I could change it at home. I was SUPER nervous. Changing her packing meant taking a long, thin piece of gauze and stuffing it into her open wound. I watched the nurse do it, and although I didn't want to, I knew that I could do it at home.

So we finally got to go home Thursday evening. We made it home in time for dinner. Olivia was so happy to have everyone home. While Ellie and I were gone, she had a hard time sleeping, and the first thing she would ask her daddy in the morning was where Ellie was and if she was still sick. I had to make a chart of all the different medicine Ellie had to take and when she had to take it just so we could keep things straight. Packing her wound was traumatic, but I only had to do it 4 times. After about a week, her wound had healed up enough that we didn't even need to bandage it. All that is left now is a small scar!