Just Plain Ruff Posted August 14, 2008 Posted August 14, 2008 You are called to the very rural residence to a infant in distress. This is a 5 day old baby with rapid respirations and poor color. They called because the child has not been feeding and thier car is broken down so they have no way to get to the doctor. You have no air ambulance support due to a major disaster 100 miles north of you that required all the helicopters in your service area. You have a full complement of ALS equipment and there is a guarantee that you won't run out of any of your meds and your monitor is completely charged with 5 extra batteries. In other words, you are the paramedic, you have one EMT and that's it. No first responders except one deputy sheriff that is already there and is using blow by oxygen on the baby. What are your first steps.
Eydawn Posted August 14, 2008 Posted August 14, 2008 Get baby and mom on-board and start moving. I can do all my assessment and treatment while I'm hauling butt for the hospital- this kid is going to need a doc ASAP. Vitals? How'd the pregnancy go? When did the baby quit eating? Have they been able to get the baby to drink water? BM? Urine output? Anything the family was told before being discharged from the hospital with their little one? Environmental conditions? Wendy CO EMT-B
Just Plain Ruff Posted August 14, 2008 Author Posted August 14, 2008 Get baby and mom on-board and start moving. Kid and Mom are on board. Vitals? rr=48 Pulse 170 BP 65/35 Temp - 100.2 oxygen sat - unobtainable How'd the pregnancy go? Uneventful When did the baby quit eating? Yesterday Have they been able to get the baby to drink water? NO BM? None in past 30 hours Urine output? minimal in past 7 hours Anything the family was told before being discharged from the hospital with their little one? Environmental conditions? None Wendy CO EMT-B You get your tail on board. Vitals are as above Child is not looking good. You re-request helicopter and it's still transporting. You have a ambulance full of drugs and stuff. You also notice a red spot on his sclera of his right eye. His extremities are cool with thready pulses and a delayed capillary refill time of 5 to 6 seconds
Eydawn Posted August 14, 2008 Posted August 14, 2008 Red spot as in a blood spot indicating damage from trauma? Or red spot as in allergy eye-red? What's the kiddo's level of responsiveness? Does he respond to stimuli, or is he pretty out of it? Awkward question... but has anyone shaken or dropped the baby, by accident or otherwise? Crap. This baby is not doing well. Can I get a 3 lead and a 12 lead? Let's see if we can get an IV on the little one... scalp access would probably be our best bet. Get SOME fluids in there. How do the fontanelles look? Breath sounds? Heart sounds? Bowel sounds? Wendy CO EMT-B
letmesleep Posted August 14, 2008 Posted August 14, 2008 allergies? I understand that baby is 5 days, but does Mom know anything about this issue? question the hell out of her as best as possible to see what if anything could be causing problems for the "little one". Any meds sent home at the time of discharge?
Just Plain Ruff Posted August 14, 2008 Author Posted August 14, 2008 Red spot as in a blood spot indicating damage from trauma? Or red spot as in allergy eye-red? What's the kiddo's level of responsiveness? Does he respond to stimuli, or is he pretty out of it? Awkward question... but has anyone shaken or dropped the baby, by accident or otherwise? Crap. This baby is not doing well. Can I get a 3 lead and a 12 lead? Let's see if we can get an IV on the little one... scalp access would probably be our best bet. Get SOME fluids in there. How do the fontanelles look? Breath sounds? Heart sounds? Bowel sounds? Wendy CO EMT-B you are able (miraculously) get a scalp IV 3 lead monitor showing very narrow complex tachycardia, regular in rate 12 lead - you get it and it says SVT on it. (No picture available) Baby LOC Is responsive only to that iv stick. I would be pissy too if you stuck me in the head with a needle I'm thinking of one other quick test you can do to determine if there is a easy fix to the babies LOC(think no food or drink for 17 hours) Resp rate is now 60 Pulse rate 210 now Loc dropping - no response to pain ful stimuli
Just Plain Ruff Posted August 14, 2008 Author Posted August 14, 2008 There is no trauma noted nor is there any admission of trauma. To throw a wrench in the deal - the family took him to a Mexican medical clinic in Mexico and they told them to cross the border and call your ems system to come get them. The parents speak excellent english.
ericenglund Posted August 14, 2008 Posted August 14, 2008 Glucometry, anyone? Easy rule out, as stated above. Follow ACLS/PALS "Seek expert consultation." I'd be on the radio with a doc.
ericenglund Posted August 14, 2008 Posted August 14, 2008 And did the parents notice any seizure activity at all?
Eydawn Posted August 14, 2008 Posted August 14, 2008 Would a low BGL be contributing to tachycardia like that? Get the BGL and give dextrose if warranted... What did the Mexican clinic do for the kid? Did they give him any herbal remedies or anything like that at home? Was this kid pooping normally before this all set in? Wendy CO EMT-B
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