By Dr. Anthony Policastro

When I started medical school there were only four childhood immunizations. They were polio and DPT (diphtheria, pertussis/whooping cough and tetanus). Now we have many. One of our newer vaccines is against a bacteria called Hemophilus Influenzae (H flu).

H flu was a common cause of meningitis. It also caused an illness caused epiglottitis. Epiglottitis was an infection of the back of the throat. It caused it to swell up until it blocked off the breathing passageway.

The treatment was simple. We put a breathing tube in to get past the swelling. We then used antibiotics to treat the infection. When the swelling went down, we pulled the tube out.

It was only a real issue if you missed the diagnosis. That was because the presenting symptoms looked very much like typical childhood croup. In croup the breathing passageway is also narrowed. It is at the level of the vocal cords and not up in the throat.

One night I was on call for pediatrics. I received a call from the ED to see a patient with croup. I walked in and saw that this was not croup. We confirmed epiglottitis with a neck X-ray. H flu vaccine was available by this time. I asked the mother about his immunizations.

He had been seen a month before and was noted to be behind on them. They caught him up on the ones he was missing. They decided to have him come back for H flu vaccine to limit the number of shots given at one time. Who knew that he would get sick with it within the next month?

I called the local ENT physician and told him I needed him to put a tube down this boy. He replied that he did not treat epiglottitis in children. I would have to go to the children’s hospital 50 miles away.

I got in the ambulance with the patient. The mother was in the ambulance. I took a nurse anesthetist to help manage the airway. We began the trip.

When we were about 12 minutes away from the children’s hospital, the child became extremely combative. I knew this meant his carbon dioxide was rising. That is the first sign. It meant that we had 15-20 minutes before he stopped breathing.

We pressed on. His carbon dioxide rose more and put him into what is called carbon dioxide narcosis. That is like being under anesthesia from the high levels.

About two blocks from the hospital, there was a railroad crossing. We got there just as the gates came down for a freight train. As the engine passed, the child stopped breathing from the excessive carbon dioxide. His mother thought that yelling at the long freight train would help.

I instructed the nurse anesthetist to try and force air in and out of his lungs with the bag and mask. That should lower the carbon dioxide and start him breathing again. It worked and by the time the train had passed, he had started breathing on his own.

We knew that was just a temporary measure but by that time we had arrived at the children’s hospital. They got the tube in and he did well.

I remember this story every time I read about parents who do not want their children vaccinated. I have experienced first hand just how bad a decision that can turn out to be.