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Why can't she speak?

Article Excerpt
Samantha was a previously healthy, 10-year-old female who presented to an outlying emergency department with a 1-day history of double vision (diplopia), difficulty speaking (dysarthria), ataxia, and vomiting. She denied any previous history of fever, chills, abdominal pain, cough, sore throat, dysuria, headache, or trauma. During Samantha's stay in the emergency department, her symptoms progressively worsened until she was unable to speak except for mumbling. She started drooling, leaning forward, and was in increasing respiratory distress. Samantha was treated with ketorolac (Toradol[R]), promethazine (Phenergan[R]), and IV fluids. Arrangements were being made to transfer the patient to the pediatric floor when the she had a respiratory arrest requiring intubation. This plan then changed to transport Samantha to the pediatric intensive care unit (PICU) in the closest children's hospital.

Assessment Findings

Samantha was admitted to the PICU accompanied by the flight transport team. She had been given vecuronium (Norcuron[R]) and midazolam (Versed[R]) for the flight but was waking up and moving spontaneously on admission.

Vital signs: T - 37.3C, HR - 106, RR - 16, BP - 134/62, and [O.sub.2] sat of 99% in 60% Fi[O.sub.2] per Servo-I ventilator.

Neurologic: Sedated with midazolam. Pupils equal and reactive but unable to spontaneously open her eyes. Positive grasp as 4/5 in upper extremities; able to wiggle her toes bilaterally, bend her knees; positive sensation to...

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