Tuesday, February 5, 2008

Landans Medical Records (taken from myspace)

October 26, 2007
I went and got Landans medical records today ... here is the ER Dr.s notes.
"This is a 3-year-old male who presented to our ER from Rossford. We really did not get any call prior to the patient coming in. When this patient arrived the nurse went in to get report from the ambulance from Rossford. She was talking to them and she turned around and looked at the child, saw that the child looked very significantly ill, immediatly came and got me and another nurse. We walked into the room, assesed the patient. Concern initially was with the patient's appearance, again, he did look very sick. He looked like he was in shock, a rash that was consistant with meningococcal type of rash. We immediatly tried for IC access, but the patient appeared to be in signs of shock and we were unable to get an IV.
I contacted the peds hospitalist. The message was conveyed though another nurse about our concerns about this patient being very ill and they told us to bring the child up to the pediatric intensive care unit, and he was taken up there.
The total time that we were with the patient in the ER was approximately 15 minutes from the time he got here to when he went upstairs.
Mom states that the child has no past history of any health problems, he has no allergies. She gave him some atipyretics for a fever that he had yesterday and he maybe had a little bit of some fever and not feeling well yesterday, but nothing else significantly abnormal that she reported. He has not been around any sick contacts, doesn't go to day care. The child was feeling ill. She states that he slept with her last night. She saw him early in the morning, he didn't seem to be abnormal early this morning, but when she woke up he was on the floor. She called the ambulance. When they got here, they picked him up and brought him into the emergency department.
When you look at him he is tachycardiac. He is very pale, cold skin. We did a rectal temp which was 38 *C. He had had diarrhea. There was stool all over his extremities. It also looked like maybe he had had some emesis. He had a purple rash on the skin noted. It did not blanch. A purple rash noted on his face, his ears, his chest, back, arms, and legs. Again, just extensively, very ill appearing child. Very cold extremities, poor capillary refill. Again, with this we attempted a couple IV attempts. I put him on some nonrebreather for support and immediately took him upstairs to the pediatric intensive care unit.
It was noted the child did have a little bit of a cry, very weak, and when you would examine him, touch him, or roll him he did act like he was just in pain from this. Care at this point in time was turned over to Dr. Pierre Vaulthy, pediatric intensive. I did notify the physician on call for Dr. _________ about the patient's critical condition.
PROVISIONAL DIAGNOSIS: Illness, rash, rule out meningococcemia
Jessica L. Wilson, M.D."

From the PICU Dr that took care of Landan
"The patient is a three-year-old child who was well until the day before admission when the patient developed what appeared to be an upper respiratory infection, followed and being very tired and lethargic. The patient went to bed and slept by the mother's side overnight. At 6:00 in the morning on 11/15/06, the patient had a bottle of juice and subsequently three hours later, the mother woke him up and found him to have a rash all over his body. She brought the patient immediatly to the Emergency Room at Toledo Hospital and was transferred immediately by the Emergency Room physician to the Pediatric Intensive Care Unit where on arrival the patient is noted to have a hemorrhagic rash throughout his skin. The patient has had perfusion of the extremities. The patient is awake, but somewhat moribund. The patient immediately had IV's inserted, blood culture was obtained and immediately thereafter the patient was given IV Claforan and IV steroids. The patient was then subsequently intubated and a subclavian line was inserted into the left subclavian vein. The patient was noted to have significant hypotension and was placed initially on Dopamine followed by Epinephrine drip followed by _________ drip and then the Dopamine was discontinued. The patient initially had no urine output, but developed some urine output after starting Lasix and using pressors.
PAST MEDICAL HISTORY: Really noncontributory. The patient has not had any previous significant illnesses. No hospitalizations. No known allergies. The patient is followed by Dr. John Dvorak in his office.
FAMILY HISTORY: His father has hemophilia A.
REVIEW OF SYSTEMS: Essentially normal for him other than most recently developed an upper respiratory infection without a cough, a rash on his skin. Cardiac, neuromuscular, skeletal, edocrine, reproductive were all within normal limits.
PHSYICAL EXAMINATION:VITAL SIGNS: On admission the patient has a temperature of 38.1 degrees C, pulse of 174, respiratory rate of 35, blood pressure of 75/23, weight of approximately 18kg, height of 97 centimeter.
HEENT: Pupils equal, reactive to light and accomodate. There is a range of motion. Ala are patent. Tympanic membranes are within normal limits. Oropharynx is dusky as are the lips and mucous membrane. Trachea midline.
CHEST: Clear to auscultation and percussion. No retractions.
COR: Normal sinus rhythm. S1 is equal to S2. Pulses are peripherally very weak.
ABDOMEN: Flat abdomen without organomegaly.
GENITOURINARY: Normal male genitalia.
INTEGUMENT: Hemorrhagic rash throughout the body with distal peripheral cyanosis.
NEUROLOGIC: The patient is moribund and responds only to pain.
IMPRESSION: Meningococcemia sepsis
The patient's condition is critical
Pierre A. Vaulthy, M.D."

And this is kind of the whole overview of the time Landan was in the PICU
"HOSPITAL COURSE: The patient is a 3-year-old white male who is transferred from the emergency room immediately upon arrival to the emergency room with obvious meningococcemia sepsis. The patient arrived in a Peds ICU provided with immediate IV access given steroids and IV antibiotics. The patient then was intubated. A central line was inserted. The patient continued to develop significan hypotension with vasopressors. The patient was placed on milrinone after failure with epinephrine. The patient during the night was stable including awakening during treatment of his severe peripheral cyanosis and lack of perfusion utilizing hyperbaric therapy. The patient was able to recieve 2 tretments without incident in the morning. At 0630, the patient was developing increasing difficulty with keeping his pressure up. He had excellent blood gases but was metabolically acidotic. The highest blood pressure obtainable despite being on epinephrine and milrinone was approximately 30/5. Boluses of fluid were unsuccessful in maintaining the pressure head. Despite maximum support, the patients heart stopped. CPR was not successful. The patients eyes were fixed and dilated and the patient was declared dead at 8:15 a.m.
CAUSE OF DEATH: Gram-negative sepsis due to meningococcemia. The immediate contacts of the family have been provided with appropriate ciprofloxacin therapy. Anyone other than the immediate family was told to see their primary care physicians for prophylaxis with ciprogfloxacin. The primary care physician was notified of the death and we sat down with the family after the patient passed away.
Pierre A. Vaulthy, M.D."

So if you made it this far .... thank you for doing so. Everything hasn't hit me yet, but boy is it hard to read (even type) the things I have thus far. I wish this was all untrue & Landan was still here. I still have blame for not getting him to the hospital sooner, he might still be here.

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