Over by a window …
… is a crib occupied by four-month-old Jamal, who has respiratory syncytial virus, also known as RSV. His mommy and daddy brought him to the Children's Hospital Emergency Department a few nights ago because he was having a hard time breathing. He's doing much better now, but he had a rough few days.

In the PICU, Jamal received close care from a nurse named Lauren and a critical care physician named Dr. Childs. His nurse also was caring for one other baby with RSV, but they were her only two patients.

Because it was so hard for Jamal to breathe, he didn't have the strength to eat. An IV provided his nutrition. For the first several hours, he received oxygen. He also was connected to some machines to check his pulse, oxygen level and blood pressure.

Jamal received the aerosol medicine continuously for the first 12 hours in the PICU. After that, he was able to go longer without the aerosol. First, he had treatments every two hours, then he was able to go three or four hours between breathing treatments.

Jamal's parents stayed with him a lot. For a child with RSV, the presence of parents is very comforting and calming, so having Mommy and Daddy near helped little Jamal breathe better.

After three days in the PICU, Jamal was moved to a room on the Second Floor general medical unit. Here he continued treatment, although only about every four hours for two more days. He was able to start eating again and could breathe more easily.

The Second Floor staff helped Jamal's parents learn more about RSV -- especially how to try to prevent him from getting RSV again. He got to go home after five days at Children's Hospital.

Meanwhile …
… in another bed in the PICU is 14-year-old Isabella, who is recovering from surgery. A few months ago, Isabella's doctor noticed her spine was curved, a condition called scoliosis. Her pediatrician sent her to an orthopedic surgeon, who said she needed surgery.

Scoliosis surgery involves a large incision on the patient's back and often a loss of blood. Isabella's surgery took about five hours and was very successful. But the surgery was just the beginning of her recovery. After the surgery ended, she was taken to the PICU. She was breathing on her own but was attached to various IVs and a morphine pump to help her have less pain. She was asleep for the first few hours after surgery.

Isabella had a drain in her incision, which ran down her back and was taped closed. She also was connected to a monitor for constant readings of blood pressure and respiratory status. During the first night in the PICU, Isabella did well. The pain medication affected her breathing, so she also needed oxygen. She was awake some of the time but couldn't eat, so she received fluids through an IV.

Every two hours, Isabella's nurse, Anna, "log rolled" her to change her position in her bed. She also did exercises to show that motion was intact and to make sure her pain was being controlled. Her doctor and nurse would ask her to deep cough, deep breathe and flex and point her feet.

The next day, Isabella's nurse and some other PICU staff helped her get out of her bed and into a wheelchair. The nurse helped her move a bit, and the doctor slowly decreased her pain medicine through the morphine pump.

Recovery time for scoliosis surgery is long. Although Isabella was well enough to go home, she had to rest and recover there for several months before she was well.

In the Emergency Department, the doctor ordered a spinal tap, which is a test of the fluid in the spinal column. An infection here can irritate the brain and make it swell, causing confusion and affecting brain function.

Seth's spinal tap was positive for a bacterial infection that caused meningitis. He was immediately given several antibiotics while the doctor waited for more detailed results from the spinal tap. Until the specific bacteria are known, it is necessary to use several antibiotics to be sure at least one drug will be the right one to kill the bacteria. Steroids are also prescribed to help decrease the swelling of the brain.

Because Seth was intubated and so ill, one nurse was assigned just to him. The critical care doctors in the PICU prescribed medication to sedate Seth because he didn't need stimulation. Seth's parents visited him but mostly stayed in the Critical Care Lounge down the hall so he could rest.

Monitors checked Seth's vital signs (heart rate, respirations and blood pressure) constantly, and he also had blood work drawn frequently to check his blood count, electrolytes and other information. He also had IVs for medication and an NG tube (a tube placed down his nose) for nutrition because he couldn't eat.

Seth's doctor ordered a CT scan of his brain to check the swelling and look for abnormalities that would make the meningitis more serious. Fortunately no problems were found.

Finally Seth's antibiotics began to take effect and he started to improve. He was allowed to wake up and soon was starting to breathe better on his own.

After about three days in the PICU, Seth was moved to a room on the Third Floor Medical Unit. On the Third Floor, Seth began to eat, starting with clear liquids. He was able to sit up some in his bed, too. He spent several more days on the Third Floor, continuing to receive his antibiotic medication in an IV, then in a liquid that he drank. After about a week, he finally went home.