Asthma
When the Children’s of Alabama Critical Care Transport (CCT) team entered the emergency department at a Talladega hospital on March 6, 2015, 17-year-old Quintavius Lee was in full arrest. Just hours earlier, his family had taken him there with a severe asthma attack – one far worse than any he previously had experienced. “When we arrived, three rounds of CPR had been performed by the emergency department staff,” said Myra Waddell, R.N., a Children’s CCT flight nurse. “My partner and I stepped in to assist, and we got a pulse back within a couple of minutes. “After we resuscitated him, we began aggressively treating him for acute severe asthma. We lost his pulse once more as we were transferring him from the hospital bed to our stretcher – and he received an additional minute of CPR. After we started an Epinephrine drip, he was finally stable enough for helicopter transport to Children’s.” “Our transport team saved his life,” said Margaret Winkler, M.D., M.S., F.A.A.P., F.C.C.M., and director of Critical Care Medicine at Children’s of Alabama. “We send our CCT team out, taking with them the skills and expertise of our Pediatric Intensive Care Unit (PICU). Without their arrival, I am convinced Quintavius would have died because by nature, rural hospital emergency room staff do not have the expertise necessary for cases like this. Once resuscitated, our transport team was able to get him back to Children’s for definitive care.” Even after reaching Children’s, Quintavius remained in critical condition. “We admitted him to our PICU, where he required hours of constant attention,” Dr. Winkler said. “To save his life and get him better, we had to keep him sedated for a few days while utilizing a new anesthesia ventilator (FLOW-i).” The FLOW-i anesthesia machine provides general anesthesia as a potent bronchodilator to improve the severe airway obstruction seen in status asthmaticus (acute severe asthma). “Because we have limited experience the use of general anesthesia in the PICU, we also solicited the expertise of Paty Bryant, M.D., one of our colleagues in anesthesia,” Winkler added. On Saturday and Sunday, Quintavius was experiencing brain swelling, and Winkler was concerned about how that might impact his outcome. “Based on his multiple arrests, and the severity of his disease when he presented to us, I told his family that he might die,” she said. But by Tuesday, Quintavius was beginning to wake up – and to recognize and talk with his family. On March 19, he was well enough for his family to take him home. Over the next few months, he will visit Children’s as an outpatient so doctors may continue monitoring his improvement. “Thankfully, he remained neurologically intact,” Winkler said. “With aggressive intensive care – and time – he is making a complete recovery.” Quintavius’ great-grandmother, Connie McKinney, thanks God – and Children’s – for his survival. “We are a praying family and we know God can work miracles. When Quintavius woke up on Tuesday morning and knew who he was – that was a miracle. Children’s saved his life. I don’t believe he would have made it without Children’s.”
