Rashes & Fevers (measles admission)

Chapter 47

Once I clock in, there isn’t time to contemplate Kris’s engagement, Simon’s remarriage, Amber’s pregnancy, or Corey’s move to Seattle with his family. As charge nurse, I took the call from an ER nurse requesting three beds for immediate admissions.

“Three beds? What’s happening down there? Was there a bus accident?”

“No, but maybe as bad. We’ve got three kids from two different families with fevers and red rashes. It’s measles. We’re coding a three year-old now”

Ten minutes later the ER nurse calls back with an update, “The three year-old’s stabilized, but maybe not for long. He’s intubated. We’re transferring him to you guys now. We’ll get back to you about the other two.”

While Gerald sets up a ventilator for the three year-old, Liz helps me take vital signs, and change the IV fluids to our pumps. “I really hate seeing a child suffer when this could be prevented by immunization,” she comments. “Why have so many parents lost trust in science and medicine? If you mention vaccinations to some, they react like you want to poison their child.”

“I think measles, pertussis, and polio decreased so much from recent memory that today’s parents don’t believe there’s a threat. I’ve heard some say, ‘Gosh, what’s the big deal about a fever and rash?’ or, ‘We have antibiotics now, so these diseases aren’t as serious as they were in the old days.’

“Yeah, everyone thinks childhood diseases are a thing from Little House on The Prairie,” added Liz.

“Yeah, well measles killed a daughter of Roald Dahl, author of Charlie and The Chocolate Factory in the sixties, before the vaccination was readily available,” I agree.

Once Gerald finishes setting up the ventilator, he joins the conversation, “I remember the first kid with measles I saw in the PICU. That time, the ER nurse reported they had a kid with a high fever, and unidentified red rash. No one knew what it was. So we wore respiratory masks, and isolation gowns, which was a good thing after infectious disease diagnosed measles. None of us had ever seen it.”

” I was sure grateful the hospital makes us have updated MMR immunizations. It’s supposed to protect the patients, but they protect us too,” said Liz.

A fever and rash don’t sound particularly lethal, but what is often not remembered is that measles is a virus, so antibiotics are not effective, although they are used to treat secondary pneumonia or infection.  High fevers can cause febrile seizures, and encephalopathy, which may result in deafness or permanent brain damage. That’s what happened to the child with the first case of measles I saw. Previously a healthy third-grader, she has permanent brain damage and lives in a home for medically fragile children.

“No one knows better than PICU nurses the dangers of childhood,” I added. “Kids die from so many causes: Motor vehicle accidents, drowning, falling out of upper storey windows, SIDS, choking, cancer, school shootings, heart defects and illness. The list is practically endless. If medical science can shorten it through vaccination, I’m for it. My kid is vaccinated.”

“So’s mine,” says Liz.

* * *

Report on the newly admitted three year-old with measles goes like this: The outbreak started when one of the kids was exposed at his pediatrician’s office.

“Wow,” says Liz, “The kid catches measles from another kid in a doctor’s office. Go figure.”

“Yep, and he exposed the neighbor’s kids: Four kids from one exposure. What if there were infants too young to be immunized in that waiting room?”

By the end of the shift, the remaining two children have cases mild enough to be admitted to isolation rooms on the regular pediatrics unit. They’ll be treated with IV fluids, and comfort measures. If their conditions improve, they’ll go home in a few days. If they worsen, they will be admitted to the PICU.

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