Critical Care Team Offers Young Boy a Second Chance at Life
from Practice Update, Summer 2006
It’s every parent’s worst nightmare. A midnight phone call alerting you that your child has been in a near drowning accident, he is unconscious and the extent of his injuries is unknown. For Denise and Jim Mudroch of Pagosa Springs , Colorado , their worst nightmare became reality on August 13, 2003 . Their 6-year-old son, Casey, was camping with a family friend, Liz, and seven children who ranged in age from six to 19. Their destination was Navajo Lake , a 35-mile long reservoir that straddles the Colorado-New Mexico border. The families had spent countless weekends there boating and camping in years past. The location held great memories for them and promise for another enjoyable weekend together.
In spite of intermittent rain throughout the day, the warm August weather allowed the group to kneeboard, water-ski, swim and boat all day long. When afternoon came, the group chose a campsite they had been to before, in a flat sandy area in a remote cove of the lake. Marshmallows were toasted around an evening campfire before a heavy downpour drove the group into their tent for the night.
Liz awoke around 11 p.m. to a sound that mimicked the roar of a train. She instinctively knew it was the sound of a torrent of water that was heading directly toward their campsite. Liz bolted up and screamed at the children to wake up and get out of the tent. She unzipped the structure just as the water hit and pushed the tent off its base. Liz summoned Marissa and Jenni, the two teenagers in the group, to help her control the tent which was being carried out into chest deep water. One by one, the younger children clung to air mattresses in order to emerge from the tent and were helped to the shore by Liz and the girls. Everyone was accounted for except Casey who had zipped himself into his sleeping bag. Repeatedly, Liz dove into the now tangled mess of tent, sleeping bags, clothes and camp gear without locating Casey. Several minutes passed before Liz dove one last time to find Casey at the bottom of the tent in his weighted sleeping bag.
Casey was brought onto shore apneic, motionless, unconscious, muddy and cold. “I think he’s mdead,” Liz said to the teens but out of range of the younger children. Instinctively, she started CPR. Looking to get Casey much needed medical attention, Liz then searched desperately for their motorboat that was now drifting 60 feet away into the middle of the lake. An inflatable air mattress offered the best chance of getting to the boat so Liz jumped on it and paddled to the craft. Before leaving, she had instructed Marissa and Jenni, who were trained in CPR, to continue the care which would be essential to Casey’s survival. In spite of an engine clogged with mud and debris, the motorboat started. Liz picked up the seven children and drove toward a spot where she had earlier seen a houseboat anchored. A couple aboard was summoned to care for the four younger children while Liz raced ten miles in the dark toward the marina. Sporadic cell phone service offered slim hope that Liz’s 911 calls were being transmitted during the tension-filled boat ride. Jenni and Marissa continued CPR nonstop until they reached the marina when Casey started breathing on his own, but still they continued the lifesaving care.
Two off duty firefighters were near the marina and had received enough information to react to Liz’s phone calls. They met Casey at the marina and pulled him out of the boat. Thanks to the continual CPR, Casey was breathing on his own when he was taken to Mercy Medical Center in Durango .
Liz immediately phoned Denise and Jim Mudroch with the devastating news that their only child was clinging to life, so the parents drove to Mercy Medical Center . With a body temperature of just 89 degrees, Casey was hypothermic, had ingested much debris-filled lake water and mud, and needed to be on a ventilator to breathe. The decision was made to airlift Casey to The Children’s Hospital. He was intubated during the flight, with his mom by his side.
Children’s is the only level one trauma center that cares exclusively for children and adolescents in the Rocky Mountain region. Because of this designation, a multidisciplinary care team was able to assemble immediately and provide rapid assessment and necessary interventions and treatment for Casey. The care team in Children’s Emergency Department immediately went to work to stabilize his condition.
Due to his precarious state, Casey was then transferred to Children’s Pediatric IntensiveCare Unit (PICU). The PICU team determined that Casey’s initial primary clinical concern was Acute Respiratory Distress Syndrome (ARDS), an evolving pulmonary process. This sudden, life threatening lung failure usually develops within 24 to 48 hours of certain serious injuries. Also alarming was the possibility of anoxic brain injury. Pediatric radiologists at The Children’s Hospital, who consult with the PICU care team and are trained to identify child-specific radiologic anomalies, detected cerebral edema through the use of a brain CT scan. A second CT scan of the lungs revealed patchy infiltrates and edema throughout both lungs. A decision was made to initiate medically induced sedation and paralysis to allow for ventilation and promote healing for the six-year old boy. Denise and Jim were naturally anxious that their only child was hospitalized in Children’s PICU. They realized that this department cares for the sickest children in a hospital that is best known for treating the most medically complex patients. After two and a half weeks in the PICU, they were thrilled that Casey showed enough improvement to be transferred to Children’s 5N Inpatient Unit for neurotrauma rehabilitation care. This unit is the only one of its kind in Colorado . Later that same day, Casey experienced a major setback with significant blood loss secondary to a gastrointestinal bleed. He became obtunded and hemodynamically unstable. He was quickly transferred back to the PICU.
Denise and Jim felt relieved that their son was again being cared for by the exceptional critical care team. The team worked for seven hours to bring Casey’s bleeding under control and stabilize his condition. As Denise described it, “The PICU team never gave up or relented. Although we were anxious that Casey needed to return to the PICU, we felt the critical care unit was the best place for Casey to be and he was receiving the best care possible.”
Throughout Casey’s five-week hospital stay, Denise and Jim noted the exceptional care that was provided for their son. “Awesome. Amazing. Simply the best.” Those are the words Denise used when she described the PICU physician and nursing staff. “We had the same doctors and nurses day after day and we got to know them very well. I loved that the staff always put Casey first when they entered the room. Every effort was directed toward him and his recovery.”
Eventually, Casey improved enough to begin rehabilitation therapy again. Physical, speech and occupational therapies all contributed to Casey’s recovery. Each therapy session was individualized for Casey and his abilities and age. On days when he was too weak for therapy, Casey could return to his room for rest. Jim Mudroch stated, “The Rehab Department was great about squeezing Casey in for make-up appointments. The sessions were always oriented toward fun, child-like activities which helped keep Casey engaged.” National studies show significantly improved outcomes for brain trauma patients with early initiation of neurotrauma rehabilitation. At Children’s, on-site rehabilitation can begin shortly after admission to the hospital.
The Critical Care Team also worked closely with Casey’s family medicine physician in Pagosa Springs. The care team regularly talked with the primary care provider to answer his questions about Casey’s on-going care and also sent information about medications and allergies to be included in Casey’s permanent medical record. The PICU staff was also available 24/7 to the Mudrochs to answer any questions they had. Both the physicians and nurses spent time explaining the procedures and tests that Casey was undergoing. The family commented on the patience that the care team demonstrated while answering all of their questions in language they could easily understand.
One milestone that was celebrated at Children’s Hospital was Casey’s seventh birthday. Although the hospital staff did their best to create a festive atmosphere with clowns and cake, the Mudrochs threw another birthday party for Casey when he returned home to Pagosa Springs that fall. Imagine their surprise when Casey chose the pool at the local recreation center as his party venue!
Casey is now a healthy and happy nine-year old boy who loves to swim, fish and collect snakes and caterpillars. He has no long-term ill effects from the accident and still has no fear of the water. Denise and Jim Mudroch credit The Children’s Hospital with Casey’s complete recovery. Denise summed up the family’s experience at Children’s by saying, “The hospital is so child-oriented. I don’t know how he would have fared in an adult hospital. It takes incredibly special and loving people like the PICU staff to care for such sick kids everyday.”
