Pediatric Arrest 2

John pulled into the station right behind me. He is a supervisor for a construction company, and he normally works nights. John is a solid guy, even keel and good under pressure. He is reliable and I was glad to see him. “This might not be good” I said as I climbed into the cab of the ambulance. “yeah” “793 enroute BLS” I said on the radio “793 echo response for an 8 day old in cardiac arrest. I reviewed the steps for infant CPR in my head and put my gloves on as we drove down the empty early morning roads. 8 day old kept repeating in my head. “I’ll grab the O2. You grab the med bag.” I said as John pulled into the driveway of an old small white farmhouse. I hopped out and hustled to the front door. An older woman met me. “I think she is ok now.” I walked into the living room where a young high school aged mother sat in a love seat and held her sleeping baby on her lap. Her sister sat on a couch and her mother, the woman who met me at the door, sat next to her. The baby was pink, and breathing. Ok. Good. For a minute I didn’t know what to do. I was so intent on infant CPR, that I forgot what to do for an infant not in arrest. Ok breathing, adequate. Pulse. I felt for a pulse on the brachial artery on her upper arm and after changing positions a few times finally felt the faint rapid tap on my fingers. I got the story from mom, and grandmom interrupted frequently. She was feeding her baby when the little girl suddenly projectile vomited. Her face turned deep red. “Did her face turn blue or purple?” I asked as I took my stethoscope from around my neck. “No.” “How long did this last?” “About a minute, then she started to cough and choke” “But her face stayed red, it didn’t get blue or violet?” “right” “EMS lieutenant 73 dispatch negative arrest.” I said over the radio to let other units to know they can reduce their rates, they can relax. I was still on edge. Something happened that scared the hell out of this family, and so I was scared too. I listened to this little girl breathe. The large head of my stethoscope covered almost her whole chest. I was listening for any abnormal noises in her lungs. She could have aspirated, or inhaled vomit into her lungs which would explain the coughing and choking mom described. All I could hear was the whisper of air moving into and out of her lungs unimpeded. It didn’t sound like she inhaled any vomit. We taped a pulse oximiter probe to her foot, to check how much oxygen was circulating in her blood…100%. She didn’t have any medical history, wasn’t taking any medications and was delivered at term without complications. She appeared to be a very healthy baby girl, who just scared the hell out of her mom, aunt, grandmother and about a dozen first responders. Paramedic 1, and our EMS chief arrived. I gave my report and they felt that I could transport the baby as a BLS patient, that she didn’t need any advanced life support measures, and I agreed. John drove non-emergency to the hospital, as I closely monitored the baby. I was afraid of the what ifs…what if this baby went into arrest enroute? What if she vomited again but aspirated this time? I was confident I would be able to handle any situation, but still I was afraid. I tried not to show my fear. I need to present confident and unshaken to my patients to gain trust. And I had a 16 year old EMT student riding with me. I explained what was going on as we drove to the hospital, explained that I was thinking of possibilities to the EMT student, and preparing for them mentally. I had the EMT student check vitals every 10 minutes, and I rechecked him until I knew I could trust that he was giving me accurate information. I kept the protocol book opened to the infant bradycardia and infant CPR algorithms, and anticipated problems. I usually don’t ride with the protocols open, I know them. But I don’t see many infants in my practice so the open book was a reassurance that I knew what to do. I was very attuned to this baby. When she fell deep asleep, her heart slowed, and oxygen levels dropped, but all stayed within the normal range. However I was ready. I knew where the infant BVM was, and I knew where we were and what ALS was available if I needed it, or if it just made more sense to run like hell to the hospital. I called the hospital on the radio to give them a report of our patient, so they were ready for our arrival. They waved us to room 19 where 2 nurses waited. I told them what we saw, what our exam found, and that transport was unremarkable. They took it from there and that was that. From complete terror to mundane. I met with the charge nurse and asked if there was something different I needed to do for my patient, if there was something I missed in my assessment or a treatment I should have implemented. She said no, you did everything great. We are calling this an ALTE (Apparent Life Threatening Event). I thanked her and we left after putting a clean sheet on the stretcher. My knees got weak when I went to climb into the cab to go home, when I realized the call was over, we are clear and we delivered this infant to the ED alive. It was ok to feel a little weak then. I got home at 5. I tried to sleep for an hour, got out of bed at 6 and went to work.