1. archerfenris
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    archerfenris Active Member

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    Pneumonia Symptoms

    Discussion in 'Research' started by archerfenris, Dec 8, 2014.

    Here's a question for the Nurses/Medical professionals here:

    In my novel I have the MC, a young female adult, experience a near-drowning. I know near-drowning's can have serious medical consequences. One, I've read, is pneumonia. Apparently a high fever and hallucinations are possible (if the fever is high enough) in serious cases (Along with breathing difficulty and chest pains, of course).

    I have the MC hiking through mountain valleys and trails a day after she's nearly drown in which the bacteria infects her (is "infect" the right word? Forgive my medical ignorance). By the second day her fever starts and by afternoon it's so high she begins hallucinating before she collapses. This is all with zero medical help...just her body fighting it off.

    My question is: How much would she be able to do? How long does it take, from the point of drowning, before symptoms occur? I figured she had a 103 degree fever around the time she collapses (as in, very serious). This is exacerbated by the fact she's hiking through a rain storm (yes, I remembered to add shivering). But would a woman with a fever climbing to 103 degrees be able to hike over mountain trails, up steep grades, down steep grades, through forest and into mountain streams in a rain storm? Would her body, unable to control her temperature, just give out? She probably did this for about 5 or 6 hours before collapsing.

    I appreciate your help!

    Edit: Temperature would be around the high sixties in the afternoon but around mid fifties when she woke up. Rain started late morning.
     
  2. Shadowfax
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    Shadowfax Contributing Member Contributor

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    Depends how young and how fit. Because she's out hiking alone, presumably well-'ard.

    But my googling of near-drowning leads me to believe that the distinction between drowning and near-drowning is the point at which they give you up for dead, i.e., you don't "escape" from a drowning experience without outside intervention (somebody to pull you from the water), and probably resuscitation. So what happened to her rescuer?
     
    Last edited: Dec 8, 2014
  3. Fitzroy Zeph
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    Fitzroy Zeph Contributing Member Contributor

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    I sailed down the west coast of the US to San Fransico from Canada when I was 50 with what turned out to be pneumonia. I hacked and coughed and was so damned cold. I couldn't sleep properly or eat and lost tons of weight. I kept going for many days like this. Depends on what type of pneumonia you have. I never "dropped" in delirium. I just kept my same assigned watch, midnight to 6 am every night. Oh yeh, and I kept puking just to take my mind off the cold.

    I find scenes where the MC is sick overplayed in books and movies most of the time, not to mention tedious and better served with other forms of tension. Just my opinion though.
     
  4. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Pneumonia symptoms depend on the organism growing in your lungs. Quite often all you have is a low grade fever, weakness/tiredness/shortness of breath and night sweats. But you can have a high fever as well so you can put that in your story.

    @Shadowfax is right, you don't usually inhale water until you are unconscious. How is she going to escape the water without help? Inhaling water would immediately cause a gag/cough reflex. She'd have to wash up on shore at just the right second after unconsciousness for the gag/cough reflex to expel water from the lungs and allow air back in.

    As for timing, again that depends on the organism and the dose inhaled. So really dirty water might produce mixed-organism infection as soon as 24 to 48 hours. Clean water might result in a small dose of a single pathogen and symptoms might take a week.

    You need not worry too much about fitting your story to the symptoms because there is a broad range of incubation periods and severity with aspiration pneumonia. You have more of a problem explaining how a near drowning wasn't a fatal drowning.

    By the way, I have heard the diagnosis of "drowning" applied to patients who were in the hospital and not dead. It's always an odd diagnosis to hear because one thinks drowning always means it was in the past and was fatal.
     
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  5. Sifunkle
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    Sifunkle Dis Member

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    The feedback others have given is great :) As they suggest, you really have two problems: the drowning itself, then the complication of pneumonia. I agree with @GingerCoffee that 'drowning' is technically the aspiration of a large quantity of fluid, not necessarily death - the others have given good pointers on drowning, so I can't add much.

    Regarding pneumonia: the water itself will cause an initial inflammatory reaction in the lungs (i.e. pneumonia/pneumonitis in the strict sense), but clean water is only a mild irritant (note that I'm only talking about inflammation - having fluid in the lungs will still interfere with respiration in other ways). If the water is dirty, with lots of suspended particles of plants, earth, etc, that will cause more significant inflammation.

    As you've identified, your ongoing problem with pneumonia proper will probably be from a bacterial infection arriving via the contaminated water (yes, 'infects' is a correct word :) ). As @GingerCoffee said, this will depend on what microbes are involved (the initial 'infective dose', nasty characteristics the particular bugs have, how quickly they can multiply to a problematic level, etc).

    May include:
    - Higher respiratory rate than normal, and much more effort required to breathe
    - Chest pain (perhaps not extreme, although if it went on long enough it could evolve into another type of pneumonia that would cause severe chest pain)
    - No particular difference in pain/discomfort between inspiration and expiration
    - A cough, but it might be a fairly weak one compared to e.g. laryngitis - more of a soft grunt
    - She could potentially feel little pops/crackles in her chest (this is what a doctor might listen for with a stethoscope)
    - If it's more severe she might bring up mucus/pus/blood
    - Fever is certainly common: this implies that the bugs have entered her bloodstream at some point. I don't speak Fahrenheit, so can't comment on your numbers. Hallucinations are possible, but I think general delirium would be more believable.

    In terms of what you're having her do, it sounds quite taxing, but as @Shadowfax says, maybe if she's young and fit, and has the willpower for it.

    I'd think her abilities would be most affected by 1. fever and 2. respiratory impairment.

    Fever is basically the brain raising the body's thermostat in the hopes that the bugs will find it more intolerable than the body itself does. Fever may help the body win the war, but the body certainly won't function as well while outside of it's normal optimal temperature.

    The lungs' basic function is to bring oxygen in and saturate the blood with it (and the reverse for carbon dioxide). Oxygen is a fuel that the body in general needs to function, including the muscles and the brain. The bloodstream sends it all over the body. Oxygenated blood is bright red. Blood without oxygen looks more of a dull purpley-blue colour.

    The lungs are made up of thousands of tiny balloons called alveoli. These alveoli stay 'inflated/open', even at the end of an expiration (before inspiring again), because special lung cells make a natural detergent that overcomes the surface tension that would cause them to collapse. The alveoli need to stay open in order for oxygen and carbon dioxide to be exchanged between the bloodstream and the air.

    In pneumonia, a whole lot of gunk (mucus, pus, etc) will fill the alveoli and cause them to stick shut via increased surface tension (imagine you have two pieces of wet paper pressed together - they're hard to pull apart), which means that those alveoli can't be used to move gases in and out of the blood. Not all of the alveoli will be stuck shut (otherwise you'd be dead pretty quickly), but the proportion stuck shut will reflect the level of respiratory dysfunction.

    (By using extra effort to inspire, you can force the 'stuck' alveoli to open up again (like blowing up a balloon - the first part is always hardest. Once it's inflated somewhat, it gets easier to inflate it more). The pops/crackles I mentioned earlier are the sounds of stuck alveoli springing open. But you might not be able to breathe in with enough effort to get them all to pop open. If alveoli are stuck closed for long enough, they'll eventually stay that way irreversibly - part of the lung may seem 'collapsed'.)

    Anyway, if her lungs aren't able to exchange gas as well as they normally can, she'll find herself much more weak and tired than usual. Her ability to use her muscles will be limited by her reduced ability to supply them with oxygen via the bloodstream. If she forces herself to use her muscles, she might reduce the overall levels of oxygen in her body - perhaps she'll even 'turn blue'. If her muscles are so greedy for oxygen that they deplete her blood of it, her brain might not get enough oxygen and she might faint until her underperforming lungs are able to restore the balance. Potentially she could even deprive her heart of oxygen, which could also lead to fainting via the brain missing out too, but she might have a harder time recovering from that...

    I think if you want to portray her struggle through the wilderness realistically, you should consider:
    - Emphasising exactly how tired the effort makes her feel and how much faster/harder she has to breathe than normal
    - Making her stop to rest frequently, as she will probably feel her muscles begin to fail much sooner than normal
    - If she's pigheaded and insists on pushing her body too hard, she might faint
    - With a lack of medical treatment, and especially if she's stressing her body by pushing it hard, her illness is likely to worsen over time (stress = poorer immune function). She'll find it increasingly difficult to keep going, and may eventually reach a point where she can't.
    - Whatever fever-specific complications you want to throw at her. People can do pretty crazy things when they're delirious. I'd advise you put some research into that.

    Things get more complex, and there are exceptions to what I've said, but I hope this is an overview that you can glean some use from. All the best!
     
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  6. archerfenris
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    archerfenris Active Member

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    I don't know who said you don't inhale water until you're unconscious but I've certainly done it. I was doing "water survival training" in the army and they put some gear on me, gave me a weapon, and told me to swim 10 meters. I started sinking halfway there, panicked and inhaled some water (panic even more!). This similar event happens to the MC. She's forced underwater by an attacker and through her fight with the man, inhales a lot of water.

    Further: I am a TOTAL idiot. I forgot to add she's not alone. She was rescued by her comrades, she's in a group of about fifty. These friends help rescue her but they all have to run (for their lives) several miles, then proceed over the next few days to climb switchback mountain trails, and sometimes go over rough terrain (no trails) in said mountains. The entire time they're being pursued and so the MC is pushing her body to the absolute limit. However, she is in very good shape. I'd say, comparably, on par with a collegiate athlete.

    So, reading your guys replies, I'm not sure if I've over estimated the effect of pneumonia on a perfectly healthy and fit young woman or if I've hit the nail on the head due to her physical exertions.
     
  7. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Are you sure you inhaled the water and didn't just get it far enough in to choke on it? However, if you say you couldn't stop the reflex to inhale before losing consciousness, I believe you.

    As for it being impossible, if I said that I misspoke. People aspirate fluids all the time.

    @Sifunkle, all good details. One quibble, fever doesn't necessarily mean sepsis. Though the lungs are a common portal of entry for pathogens that cause sepsis. Also, adding to your detailed list, inflammation thickens the alveolar membrane which is another impediment for O2 and CO2 diffusing across the membrane.

    Are you a physician, a nurse, or something else? :)
     
  8. Sifunkle
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    Sifunkle Dis Member

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    Very true :) and I'm 'something else'. Sorry that's not much of an explanation: it's all a bit complex/pathetic.
     
  9. Jack Asher
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    Jack Asher Wildly experimental Contributor

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    If she's getting down to the point where she is shivering she is in serious trouble. Little shivers are normal, occasionally and briefly. If she's really shivering (what we call "core shivers") she's in the early stages of hypothermia. 50 degrees in the rain over mountainous terrain would be cause to be very careful for a healthy person. The fever and hypothermia are going to have it out over her body. If she's not wearing cotton the fever might win. If she's in cotton and in the rain for 6 hours hypothermia is a far more pressing concern. I don't think there have been many experiments, but the bodies ability to regulate it's own temperature is probably going to go more cold than hot as she looses energy.

    As far as "possible with a fever" it really depends on the person. We've pulled people off the mountain for painful bee stings, and we've had people hike into the hospital with broken bones.
     
  10. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    I doubt 'pathetic'.
     
  11. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    It does rain in the tropics. ;)

    I think he meant fever and chills, not shivering from hypothermia.

    But your points were valid and need consideration if the setting is cold and rain.
     
  12. archerfenris
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    archerfenris Active Member

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    I have the temperature in a pleasant range of 60 some degrees during the rain storm. She's not wearing cotton but rather linen undergarments (flax, not cotton) with a mix of wool/canvas/leather outer garments. As for hypothermia the others in the group are quite pissy but not shivering. At the point she faints, however, they are moving through a mountain creek (slightly higher than knee length water). The water is colder than the temperature and the season is late spring.

    @GingerCoffee Oh and I apologize. You're right. I really did breathe the water in. I felt it going through my airways and I freaked out (still don't like water to this day, despite having no fear of it prior to this), surfaced, and coughed like crazy.
     
  13. jebris
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    jebris New Member

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    Tnx for great information man!
     
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  14. Lance Schukies
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    Lance Schukies Active Member

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  15. Lance Schukies
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    Lance Schukies Active Member

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  16. ChickenFreak
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    ChickenFreak Contributing Member Contributor

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    I once got inhalation pneumonia from laughing really hard so that I breathed in iced tea that had been sitting on the counter for about a day and a half. I'm just saying.

    (But that was presumably seen as an unlikely diagnosis, since the first medical professional I saw declared it to be a cold and sent me home, where it got worse for a few more days.)

    (We put our tea in the fridge now, in case of future laughing incidents.)
     
  17. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    This comment depends on a lot of variables, like how clean the water is, for example. As for age and speed of onset, again that depends on the pathogen(s) growing in the lung.
     
  18. Lance Schukies
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    Lance Schukies Active Member

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    I was referring to the context of his plot. 24 hours to have strong symptoms, I am not a medic just basing on personal experience. and the news article which I think it as bad as one can get in a natural environment.
     
  19. Lance Schukies
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    Lance Schukies Active Member

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  20. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Near Drowning
    Pneumonia associated with near-drowning.
    Look at the graph on the third page (pg 898 in the journal) and you will see time to onset of symptoms listed by common pathogen encountered. Strep and staph infections are very common organisms in one's nose and throat therefore likely pathogens washed into the lung when one drowns. They both have an onset within the first 24 hours and can be very severe in all ages.
     
  21. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Dude, you need to quit, you aren't getting any better by searching Web MD. That is not a discussion of drowning associated pneumonia. In addition, "at home" means with antibiotics unless it is purely a viral pneumonia, not something one gets with aspiration, and even with viral pneumonia we typically give an antibiotic because the fluids in the lung set the stage for bacterial overgrowth.

    I repeat: It depends on the pathogen.
     
  22. Lance Schukies
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    Lance Schukies Active Member

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    ok I am not a medic
     
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  23. GingerCoffee
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    GingerCoffee Web Surfer Girl Contributor

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    Not trying to be harsh, I just react to bad medical information like a fly to a fire. ;)

    I'm not a medic either, I'm an advanced nurse practitioner who specializes in infectious diseases. :)
     
  24. Ben414
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    Ben414 Contributing Member Contributor

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    I had pneumonia two years ago. Sometimes I coughed once, but other times I coughed in bunches of 4-7, with each cough making me need to cough again. These coughs were not weak, they were strong. By the end of each coughing episode, I was very out of breath and may have thrown up. These coughing episodes happened 2-3 times a day early on before the antibiotics started doing their thing. I'm not sure if you'd want to add something like this, but it might continually build tension if this kept happening to her while she was trying to hike, eventually leading to the delirium.
     
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