This case involves a 12 year old male with a history of asthma. He had a physical exam, and was diagnosed with a sore throat and given antibiotics. A few days later, the patient developed a cough as well as a slight fever. The patient then presented to a pediatrician with complaints of pain on breathing. At this point, the physician gave him a prescription for nebulizer treatment to be administered several times a day. A few days later, the patient again went back to pediatrics, where he was again dismissed. A few days after this visit, the patient presented to the emergency room where he was diagnosed with pneumonia in the left lung middle lobe. The doctor did not change his medication at that time and he was again discharged. He was taken back to hospital again after several days, where he was prescribed steroids and painkillers and was released home. A few days later, the patient was complaining of pain in his back. The patient’s mother called an ambulance, and he was taken to the hospital, where he was started on an IV and blood was drawn. His blood pressure and cardiac rate were low, and it was soon discovered he was in septic shock and had had a prolonged infection. His heart rate dropped significantly, at which point CPR was initiated. After attempting to resuscitate him, the patient was pronounced dead. It was determined that the patient suffered from acute viral pneumonia.
Question(s) For Expert Witness
- 1. Do you treat patients similar to the one described in the case?
- 2. Have you ever had a patient develop the outcome described in the case? What could have been done for the patient to avoid such an outcome?
Expert Witness Response E-007428
I am a board certified pediatric emergency physician with 20 years of clinical experience. I am also an Associate Professor of Pediatrics at the Medical University where I work. I have treated many pediatric patients with Influenza. I have also treated many cases of septic shock and have led many resuscitations of critically ill children. Influenza is known to be more severe in children with Asthma. The CDC (the Centers for Disease Control) recommend treating children diagnosed with influenza with an antiviral medication called Tamiflu. It is thought that early institution of this medication may lesser the severity of the disease and decrease complications such as pneumonia or sepsis. From reviewing the case, I think it likely that this child developed one of these complications. If the health care providers had diagnosed influenza early in the illness and started Tamiflu, his deterioration may have been prevented.
Expert Witness Response E-007322
In my study of virology I’ve seen viral pneumonia hundreds of times. This is not how this tends to go with an immunocompetent patient, asthma or not. Secondary bacterial pneumonia happens quite often with influenza. From the limited history here, they focused on his asthma and never started him on any antibiotic since the ZMax the week before (which he likely finished a least a few days before this illness started). His signs and symptoms were never going to improve without treating the secondary pneumonia. It also looks like they never started steroids orally or by IM/IV. If they were sure this was flu and asthma then oral steroids would have been a good choice somewhere in this course. It wouldn’t treated the pneumonia, but it would have helped his asthma.