Trainwreck #5

[Sam Adams]

I don't think it was mentioned, maybe it was assumed, but bulb syringe the little one, also would like a heel CBGL.

 

[abckidsmom]

I don't think it was mentioned, maybe it was assumed, but bulb syringe the little one, also would like a heel CBGL.

Good catch. It's hard to remember to state these things when you can't see the goo in his little airway.

 

[BeachmedicJB]

given this patient's history of preterm delivery, drug abuse, and overall health. Along with the contractions being so close and the appearance that the fetus is descending and delivery pending. I would ask the sending facility to perform another cervical exam, standby a NICU rig, and hold on for the ride. Although her vitals are stable, it doesn't seem like a good idea to transfer her at this time. Other variables would play into my decision such as traffic, weather, etc. but overall my general impression is that it is better to deliver this child in a controlled environment rather than risk both the child and mother's lives for a transfer.

 

[Sam Adams]

I'd also consider a neonatal dose of naloxone see if that picks up the respiratory drive.

 

[abckidsmom]

Your doing great so far.

The only thing I might add is if the HR doesn't increase with stimulation you might want to consider chest compressions. Fortunately the HR came up, but your sats are still poor. Time for a 5 min APGAR. Pt is still cyanotic, HR is 140, pt is grimacing with your ventilations, some muscle flexion is noted with occasional, gasping respirations.

Pit is going in on Mom, seems to be helping (although, the family services folks might think a hysterectomy would be a blessing).

Anything else we can do for the kiddo? I'm thinking of two more particular interventions...

So the 5 min APGAR is 5. We could probably go ahead and intubate him, though I'm loathe to do so in our current environment. In a moving ambulance, it takes at least 2 pairs of hands to care for an intubated neonate safely, and I'm not loving our odds.

I like the idea of checking his sugar. If it's low, we'll get some access (yeah right) or consider an IO (is there a gestational limit to IO? I seem to remember something, but a quick google isn't turning it up? Can this 27 weeker get an IO?). Then we can give him a little D12.5 if he needs it.

I'm down with the narcan, but I seriously doubt that's his little problem.

It's early for him to be feeling the pain of sepsis, but we can give him a little tiny bolus and see if that helps his perfusion.

I'm breaking open some hot packs and wrapping them in towels with this kid, too, cause he is cold.

This was a bad decision, driving this woman across town. Are we there yet?

 

[usalsfyre]

Almost there. I'm not sure we have a heck of a lot of choice besides intubate, provide small amounts of PEEP and use artificial surfactant it's available at this point.

BGL and a small bolus seems like a good idea. I seriously doubt we're still seeing significant respiratory depression from any opiates at this point.

You pull in the drive and find the NICU crew eagerly awaiting your arrival with all of their toys. You breathe a massive sigh of relief...and start making phone calls.

Hopefully #6 tommorow. Review the Parkland formula .

 

[Handsome Robb]

Hopefully #6 tommorow. Review the Parkland formula .

I'm hoping it doesn't get posted when I'm in class so all the smarties get to have their way with it before I get to play

Funny you say parkland formula, we have been doing burns/trauma for the last week or so