Pediatric Arrest 1

The pagers tones pierced the dark bedroom. Somehow Joyce ignores these. At least she doesn’t complain if they do wake her up. I listened for the dispatch “medical box 707, station 7 72 73 paramedic 1, cardiac arrest for an infant 0200 hours”. Oh God no. Please no. I laid in bed for a minute, eyes wide open and debated about going. I knew I would be the first one on scene, and that there was a very good chance I would need to make some critical decisions… I would need to quickly determine if the baby was in cardiac arrest or not, and if in arrest, was it workable, or was this baby dead beyond any help? I was afraid that my skills weren’t sharp and practiced. We don’t see a lot of pediatric cardiac arrests, thank God. I was afraid of what I might have to tell the parents. Infant cardiac arrests at 2 am don’t always turn out good. Any cardiac arrest at 2 am usually doesn’t turn out good. I knew that I would most likely be there by myself for a while. There are 6 people that run EMS out of station 73. I knew two of the 6 were working that night, and one was sick. I could feel my hands shake as I pulled my boots on and headed out the door. Images of the last pediatric arrest I was on shot through my mind as I drove to the station. I was the officer on the engine running an automatic alarm about 10 miles away from our station. We were two miles from the station when the cardiac arrest was alerted. I hit the lights and siren and called dispatch to let them know we were diverting to the medical box, that engine 7 could handle the alarm. Charlie responded in brush 73. We pulled up behind the brush truck to the front of a well kept rancher. I was directed to the back bedroom by an older man when I entered the front door. The 2 year old boy was on the floor and Charlie was doing compressions. I felt bad for the kid, for the family and for Charlie. He was here by himself for a few minutes. It’s a hard place to be, especially alone. The child reminded me of my son who was about the same age. He looked like he was sleeping. His skin was pale, but not ashen grey like many arrests. Most times you walk into a room on a cardiac arrest you can tell someone is dead just by looking, you don’t need to feel for a pulse. He didn’t look dead. His red hair and pale skin made him look like he was just sleeping. He had a red and white striped shirt on, like Waldo wears. I told Charlie to stop compressions and to set up the Bag valve mask with 25 lpm O2 attached. I felt for a pulse. His skin didn’t feel cold. It felt warm. I thought we had a chance. I opened his airway by gently tilting his head back and tried to get to get a breath in with the bag valve mask. I felt resistance and his chest didn’t rise. I repositioned his head and tried again. Again no air got in. Maybe that’s why this boy has no pulse. He choked on something. I looked into his mouth and didn’t see anything. I started back slaps. Nothing came out, and I had a hard time getting air in. I tried back slaps again, with the same result. I tossed the bag valve mask to the side and tried to blow into his mouth with mine and tasted sour vomit on his lips. I got some air in, but there was a lot of resistance. I didn’t understand but went back to chest compressions. I asked Charlie to take respirations, and each breath went in, but slowly and with a lot of resistance. “Sir, when was the last time you saw him?” “About 3 hours ago. We put him down for his nap and found him.” “Does he have any medical problems?” “No, not that we know.” “Any allergies.” “No.” “Was he on the floor on in the crib?” “He was in the crib. I put him on the floor to do CPR.” The grandfather stood behind me as he answered my questions. He put his hand on my shoulder as I did compressions, as if to say I appreciate all you are doing, but it was more than that. It was a prayer from grandfather through me, to give me what I needed to save his grandson. My compressions kept blood, and hopefully oxygen flowing to the brain and heart, buying time until advanced life support could get here. I heard paramedic 1 arrive on the radio. Jane came into the bedroom a minute later. “Last seen 3 hours ago. Grandfather came into the room to get him from his nap and found him in arrest. Started CPR. No history, no meds no allergies. I had a hard time getting an airway, and its still a struggle to get air in.” I gave my report to the paramedic. She put her airway bag on the floor and assembled her laryngoscope, a flashlight handle attached to a metal blade with a light on the end that allows paramedics to visualize the vocal cords which signify the entrance to the trachea. Air travels from the nose and mouth through the trachea into the lungs. Paramedics must pass endotracheal tubes through the vocal cords in order to successfully establish a secure airway. If they pass a tube without seeing the cords, or at least the arytenoid cartilage below the cords, they run the risk of tubing the esophagus which puts it into the stomach and does nothing for delivering oxygen to the lungs. Jane inserted the laryngoscope blade into the boys mouth and when she pulled up to move and hold the tongue out of the way she quietly said to me “How long has he been down?” so the grandfather couldn’t hear. ”Last seen three hours ago” “His jaw is rigored, I can’t get the tube. Oh Jeeze. We should call it” I felt like a fool for not recognizing that the boy had been dead long enough for rigor mortis to set into his jaw already. That explained why I had difficulty opening his airway and ventilating. We continued to work him, but I knew it was pointless. Still I kept at compressions with an acute focus. Everything was deliberate. The entire world existed in that room with me, Jane, Charlie, the grandfather and child. Station eights ambulance arrived and I asked Jane if she was ready to move. I told everyone what the plan was: I was going to carry the child to the ambulance. Everyone else was going to clear a path and hold doors. “Ready?” I asked, as I scooped him up and hurried towards the door. I heard a sobbing female voice come from a bedroom across the hall as I entered the living room. “Where are you taking him?” I climbed into the back doors of the ambulance that was parked in the driveway, placed the boy on the stretcher and started compressions again. Usually I would hand the patient off to the crew of the ambulance but not this time. The rear doors closed after Jane got in and we started to the hospital. She continued to attempt an airway with no luck, and I kept compressing his chest. Sweat dripped from my forehead onto the stretcher. We arrived at the Hospital and whisked the stretcher into a room packed with doctors, nurses and techs. They took over compressions and airway attempts. I watched as they transferred him from our stretcher to the hospital bed and got pushed further to the back of the crowd so that I wound up watching their resuscitative attempts through a window. I prayed that it would work, but knew in my heart it was too late. I tried not to cry. I tried to hide from other providers and ED staff. We don’t cry. Maybe we should, but we don’t. Kay saw and led me away past other firefighters, EMTs nurses. Kay is a 65 year old EMT and EMS captain at my station. She works in the Hospital ED as an ER tech and has been doing ems for decades. She knew everyone and everyone knew her, and she had a huge heart for sick and injured people. Sometimes her huge heart got her into trouble. So when I started to sob, she knew. She had been there. There isn’t really any private space in the ER, but we found a corner where she hugged me and let me cry and just said “Its ok.” We walked back to the room where the ED staff worked to resuscitate the boy. An ER tech said to me “can you believe his mother didn’t want him anyway?” I was too numb to let that idiotic comment register. Everyone responds to fear and stress different I guess. I was there when the doctor said “we’ve been at this for 45 minutes and there is no change. Can anyone think of anything we are missing?” Silence. “Can anyone think of any reason we should not stop?” More silence. “Time of death 1453.” I haven’t fully recovered from that yet. I don’t think we ever really do. I haven’t forgotten and don’t think I ever will. I don’t want to forget. I just hoped tonight wasn’t going to be a repeat.