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Interviewer: Why is pneumonia so dangerous? That's next on The Scope.

Announcer: This is "From The Frontlines," with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: It's a little shocking, but when you look at the top 10 causes of death, pneumonia comes in at number eight. Doesn't seem like something that should be that deadly, but it is. Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. Why is pneumonia so dangerous? Why is it so deadly?

Dr. Madsen: Well, pneumonia's deadly because, you think about the ABCs, we talk about that, and that's exactly what pneumonia hits. The airway and the breathing. So the first two things, number one and two priority. When you've got something like pneumonia and it settles in, it could take a person pretty quickly, and I think it makes it on the top 10 list because really the people it affects are old people. Pneumonia has been called in the past "The Old Man's Friend", you may have heard that term. I don't know what a great friend it is, but...

Interviewer: Yeah, it doesn't sound too good to me.

Dr. Madsen: But the idea is that it's one of these things that historically has taken an older person and essentially gradually ended their life. It often eases them into death. It's often not a struggle or a horribly painful death, historically. I think that's why it got that term. But it is something, when we talk about deaths, we're talking primarily about older people who get pneumonia.

A lot of times, in those older people, you may not recognize pneumonia until it's really progressed just because older people are less likely to have fevers, they are less likely to maybe even report they have pneumonia. Maybe they don't have a good cough reflex, they've been aspirating, or breathing food or water into their lungs. So gradually, it's been building up in there. And then when you realize they have pneumonia, it's progressed quite a bit.

So these are the individuals who then come in the ER and we see them and they just have a very severe pneumonia. Maybe no one's been checking on them too much, maybe they're already a little confused all the time, and then they just seem just a little more confused and that may be the only sign of it. So pneumonia, that's who it hits, and that's who it hits pretty hard. That's really why pneumonia is one of the big killers.

Interviewer: And what exactly is going on with pneumonia? You catch it like you'd catch anything? It's a virus, a bacteria?

Dr. Madsen: Pneumonias can be caused by viruses, but typically when we're talking about pneumonias that kill people, we're talking about bacteria. The pneumonia gets in their lungs, works its way down in there, the bacteria get in there either through something they were exposed to that gets down in their lungs, or they have what's called aspiration pneumonia where they're breathing something into their lungs, and then that sets them up for a bacterial infection to settle in there.

Maybe they had a virus, maybe even the flu. The flu can cause inflammation in the lungs, weaken it, make it more likely for bacteria to settle in there. Whatever it is, typically the serious pneumonias are caused by a bacteria that get in the lungs, maybe just one side of the lungs, maybe it's both sides, maybe it's the upper part, the lower part. Different bacteria tend to attack different places in the lungs.

But the bottom line is that bacteria get in there, causes an infection that just continues to grow. That then causes them to have more difficulty breathing. They're not moving air into their lungs as well, not getting oxygen in their body. And then that infection, like an infection anywhere, can then affect the entire body, where it just causes the blood pressure to drop, causes the heart rate to go up. The blood pressure just can't sustain itself and that whole cycle is what eventually leads to death.

Interviewer: Wow. It's a little scary that you say that a lot of times people don't realize that Gram or Grandpa have it. How do I know? Is the breathing a noticeable symptom? Difficulty breathing is pretty noticeable?

Dr. Madsen: It is. It is. Difficulty breathing and, often, the signs are very subtle. Maybe your grandparent or your parent or friend, maybe they're just not acting quite right. They just seem a little different, little more confused. Maybe a little bit more of a cough. Something where in a younger person, you might think, "Ah, they just got a little something in their throat, maybe a little bit of a cold." Just even a little bit more of a cough can be a sign of something really serious in an older person.

Interviewer: So those minor coughs in an older person is something you really should pay attention to? Gotcha.

Dr. Madsen: Exactly. If someone comes in with a minor cough, absolutely. That's something where you definitely want to get a chest x-ray on them to see if they do have something down in their lungs.

Interviewer: All right. If somebody gets to you in time, is it reversible?

Dr. Madsen: It is, yeah. Most cases, we can treat with antibiotics, maybe we can treat them at home, just depending how they're breathing, how their vital signs look, looking at their blood work. Maybe they require hospitalization. But it's those severe cases where they're just really having a hard time breathing, those are the tough ones. And often, those cases, when someone comes in we have to intubate them, put a tube down their throat to breathe for them. Those are the really tough ones for them to come back from, just because it's so advanced.

Interviewer: What's the advice that you would have for somebody that has an older parent or grandparent? The takeaway that I'm taking, and maybe this isn't right, is if you're noticing the confusion and maybe just a cough that you might normally blow off for yourself, but it's an older person, take it seriously.

Dr. Madsen: That's exactly right. Don't expect them to have the same symptoms you're going to have. Don't expect them to just look absolutely miserable and have really high fevers and just be coughing incessantly. Can be a subtle cough, maybe just a little bit of a fever, something that's not even quite a fever. Or just they're a little bit more confused. Those are all signs that they probably need to get checked out.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Announcer: Is it bad enough to go to the emergency room or isn't it? You're listening to "ER or Not" on The Scope.

Interviewer: Time for another edition of "ER or Not" today. Your kid got a raisin stuck up their nose. Is that a reason to go to the ER to help get out of there? Doctor Troy Mattson is an emergency room physician with the University of Utah Health Care. Raisin up the nose, ER or not?

Dr. Madsen: Okay. I'm going to tell you something really gross here.

Interviewer: Okay.

Dr. Madsen: It's something you can try to home to avoid the ER and avoid the urgent care if you are brave. If you're the mother of this child that stuck a raisin up their nose, one trick you can do, and again avoid the ER, avoid urgent care entirely, it's actually to take your child, put your mouth on their mouth, almost like you're giving mouth to mouth, blow into their mouth, and with a little bit of force, it will then . . . the child will react by kind of closing off their airway, that air will go up into their nasal passages and blow the raisin out, probably onto your face.

Interviewer: Really?

Dr. Madsen: Along with some mucus, but that's a little trick. So this is one of those things you can go to the ER if you want. What it would mean in the ER as we would take a look up there. Try to find this raisin. Look up there with the light, sometimes have to use something to open up the nostril little bit, reach up there with some forceps and pull the raisin out. But if you're brave, that's a trick you can try at home. Actually blowing in your child's mouth and then being brave and knowing that you're going to get some mucus and a raisin on your face.

Interviewer: This sounds a little sketchy. Is this actually supported by research? This is an okay way to do it?

Dr. Madsen: This is supported in medical textbooks and in the medical literature.

Interviewer: Is it really?

Dr. Madsen: Yeah, it's actually something that is recommended if a parent wants to try it when they bring a child, a young child to the ER.

Interviewer: Well, that's one of the first things you'll recommend they try?

Dr. Madsen: I'll put it out there if they want to. I can't honestly say I've ever done it. Again, I've read it in textbooks and it has been recommended, but it's a trick. If I had a young child, I would probably try that before going to the ER.

Interviewer: It'd be fascinating to talk to somebody who's actually tried that.

Dr. Madsen: Yeah.

Interviewer: So would that work with most things that have been stuck up the nose? At least as something to try first?

Dr. Madsen: It's not unreasonable to try. I wouldn't put a lot of effort into it. You don't want to be fighting with your child there and causing them a lot of discomfort with this, but . . .

Interviewer: It can't really hurt them.

Dr. Madsen: It really can't hurt them. Essentially, you're just blowing in their mouth.

Interviewer: Sure, yeah.

Dr. Madsen: With a little bit of force, blowing in there like you were giving mouth to mouth, and then their natural reaction will be to kind of shut off their airway as that air is coming in. It might expand their lungs a little bit, but then it does force that air up into their nose, and then the air going through there is going to . . . If that thing can come out with that, it's going to come out with that force.

Interviewer: Are we talking about like fast or like a good, sustained, hard pressure blow?

Dr. Madsen: We're talking about something fast.

Interviewer: Okay.

Dr. Madsen: So basically a fast blow.

Interviewer: So a lot of pressure, a lot of pressure, really quick.

Dr. Madsen: Yeah, a lot of pressure, really quick.

Interviewer: A lot of velocity.

Dr. Madsen: Yeah, exactly.

Interviewer: Yeah, right on out.

Dr. Madsen: Bing. Right on out.

Interviewer: All right.

Dr. Madsen: Your mouth is over their mouth like you're giving mouth to mouth. Their nose obviously is open. You're blowing right into their mouth, just that force can sometimes do the trick.

Interviewer: All right. So go ahead and try that first, and then if that doesn't work, urgent care?

Dr. Madsen: You could try an urgent care. They very well may send you to the ER. I just don't know if they're going to have the equipment there to really search for this thing. And sometimes if this is buried really deep in the nose, it may require a specialist, an ear, nose and throat doctor to go searching up there for this.

Interviewer: Could it work up further while you're doing all these types of things?

Dr. Madsen: Technically, if you're blowing in their mouth, it shouldn't. It's really . . .

Interviewer: Like Utah to the urgent care, you have taken 45 minutes and then they say, "I better go to the ER," could it work up and become a worse problem?

Dr. Madsen: It possibly could if the . . . especially if the kids in discomfort, and they're kind of sucking up in their nose, and that kind of thing. They're crying and sniffling and sucking, I don't know. Trying to think . . . I guess potentially, it could.

Interviewer: Okay.

Dr. Madsen: Again, it's one of those things you can always start with the urgent care, but I won't be surprised if they then send you to the ER just because they don't have the tools there or because it needs a specialist to take a look at this.

Interviewer: So the answer is that it depends how brave you are.

Dr. Madsen: It depends how brave you are. You're going to avoid a visit altogether. Don't do it if you feel at all uncomfortable doing that, but if you want to give it a try, again, it's supported in medical textbooks. It's recommended to give it a shot. No harm in really trying it.

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