# i wonder what it could be



## emtjoe10 (Aug 30, 2010)

so, a pt. 1 year old has stopped breathing.no airway, blue, pale, diaphoretic. weak pulse, no fbao seen. what could be causing this? as a bls provider what could this signify/intervention? how would you go about treating this pt.? by the way halfway through assesment when your doing back blows the pt. goes into cardiac arrest.. (allergic reaction, shock, copd?):wacko:


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## Shishkabob (Aug 30, 2010)

Could really be anything and without a more detailed assessment there is no way you'll even get close to what it possibly was.


As far as treatment, BVM, OPA/NPA... that's really all you can do as an EMT for an apneic patient.


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## reaper (Aug 30, 2010)

Breath for them


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## Veneficus (Aug 30, 2010)

emtjoe10 said:


> so, a pt. 1 year old has stopped breathing.no airway, blue, pale, diaphoretic. weak pulse, no fbao seen. what could be causing this? as a bls provider what could this signify/intervention? how would you go about treating this pt.? by the way halfway through assesment when your doing back blows the *pt. goes into cardiac arrest*.. (allergic reaction, shock, copd?):wacko:



Start CPR


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## MasterIntubator (Aug 30, 2010)

emtjoe10 said:


> so, a pt. 1 year old has stopped breathing.no airway, blue, pale, diaphoretic. weak pulse, no fbao seen. what could be causing this? as a bls provider what could this signify/intervention? how would you go about treating this pt.? by the way halfway through assesment when your doing back blows the pt. goes into cardiac arrest.. (allergic reaction, shock, copd?):wacko:



Hmmm... so you were doing back blows... was an initial breath given to indicate back blows or even a fbao?  Maybe the stimulus of the back blows in the blue ( maybe hypothermic ) pt caused commotio cordis?  SIDS caught in the act?  meningitis?  uncompensated shock from dehydration/bleeding?  genetic cardiac issue? 
One would think a BLS provider should be on top of the game in this situation of what to do, as to what caused it... may never know.


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## mcdonl (Aug 30, 2010)

MasterIntubator said:


> Hmmm... so you were doing back blows... was an initial breath given to indicate back blows or even a fbao?  Maybe the stimulus of the back blows in the blue ( maybe hypothermic ) pt caused commotio cordis?  SIDS caught in the act?  meningitis?  uncompensated shock from dehydration/bleeding?  genetic cardiac issue?
> One would think a BLS provider should be on top of the game in this situation of what to do, as to what caused it... may never know.



As I think about this post, I am never able to leave airway... until the heart stops that is...

So, my understanding is you need to get a patent airway. Finger sweeps for obstruction, position then two breaths... if no airway, adjust the patient and try again.

When do you start doing back blows to assume you have an airway blockage?

Once cardiac arrest happens, compression only CPR right?


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## clibb (Aug 30, 2010)

emtjoe10 said:


> so, a pt. 1 year old has stopped breathing.no airway, blue, pale, diaphoretic. weak pulse, no fbao seen. what could be causing this? as a bls provider what could this signify/intervention? how would you go about treating this pt.? by the way halfway through assesment when your doing back blows the pt. goes into cardiac arrest.. (allergic reaction, shock, copd?):wacko:



ABCs. What is the chief complaint? With no airway it sounds like an allergic reaction. Then you are screwed if it has gone that far. You would need an ALS unit right away. 
COPD in a 1 year old patient?!!???!?!?! 
If he's choked on a piece of food then the back blows are correct. When he goes into cardiac arrest, start CPR immediately.


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## MasterIntubator (Aug 30, 2010)

Needs to be more specific and clear.  "No airway" to me just sounds like an uncomplicated airway with no device in it.   Was a breath tried?  Did it go in? 
If it did not go in, I call that an obstructed airway.  Then if so... it changes the ball game.  Direct laryngoscopy. 
BLS... answers in the posts earlier.


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## emtjoe10 (Aug 30, 2010)

MasterIntubator said:


> Needs to be more specific and clear.  "No airway" to me just sounds like an uncomplicated airway with no device in it.   Was a breath tried?  Did it go in?
> If it did not go in, I call that an obstructed airway.  Then if so... it changes the ball game.  Direct laryngoscopy.
> BLS... answers in the posts earlier.[/QUOTE
> 
> Two breaths with bvm attached to high flow 02, no device in place when 2 initial breaths were given, no entry to the lungs. no ALS available. no laryngoscopy in bls protocol's.


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## emtjoe10 (Aug 30, 2010)

Veneficus said:


> Start CPR



did start 1 rescuer cpr at that point in time


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## MasterIntubator (Aug 30, 2010)

Man.. you are in a pickle of a situation.  You will eventually have to get an airway to make it all work.  Waste no time to the ER.  Not a call I would want to be on.


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## emtjoe10 (Aug 30, 2010)

MasterIntubator said:


> Hmmm... so you were doing back blows... was an initial breath given to indicate back blows or even a fbao?  Maybe the stimulus of the back blows in the blue ( maybe hypothermic ) pt caused commotio cordis?  SIDS caught in the act?  meningitis?  uncompensated shock from dehydration/bleeding?  genetic cardiac issue?
> One would think a BLS provider should be on top of the game in this situation of what to do, as to what caused it... may never know.



initial given, no immediate indication of fbao except for no air entering the lungs. best reasonable thought at the time was to attempt to clear any fbao.


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## MasterIntubator (Aug 30, 2010)

Its clearer now...  That would be your worst nightmare of a call.  Make make sure airway positioning has been ruled out.  Whew....


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## emtjoe10 (Aug 30, 2010)

so if i were to place an opa or npa in pt. and still had no entry to the lungs with no visible obstruction, what to do, what would cause this. besides something that could have fallen deep into the trachea or lungs.


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## emtjoe10 (Aug 30, 2010)

emtjoe10 said:


> so if i were to place an opa or npa in pt. and still had no entry to the lungs with no visible obstruction, what to do, what would cause this. besides something that could have fallen deep into the trachea or lungs.



forgot to mention also that protocols states no blind finger sweep


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## emtjoe10 (Aug 30, 2010)

mcdonl said:


> As I think about this post, I am never able to leave airway... until the heart stops that is...
> 
> So, my understanding is you need to get a patent airway. Finger sweeps for obstruction, position then two breaths... if no airway, adjust the patient and try again.
> 
> ...



nothing in my protocol says any thing about compression only cpr, its either 30:2 (adult) 15:2 (Child) with normal  breathing rates at 12-20 adult/ 15-30 child/ 25-50 infant.

no finger sweep per protocol if nothing can be seen.
and i would not  suction if nothing is seen either, unless i heard some gurgling. adjusted pt. after 5 back blows were done. still no airway.


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## emtjoe10 (Aug 30, 2010)

i never asked the instructor and he never told me; maybe the kid had a stoma.


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## MasterIntubator (Aug 30, 2010)

I would avoid the OPA if you think there is a FBO...  the distal tip of the OPA can reach the parts of the lower mouth you can readily visualize without at least a tongue depressor.  You may lodge that object deeper.  The BLS skills are limited, but many allow deeper suctioing ( orally or nasally ) with a french cath.  You could try a 14Fr and see if that will gently glide down a few inches, apply suction and see if you can't get something cleared.

Keep working at clearing the airway and getting that O2 stuff in responding to the ED


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## firetender (Aug 30, 2010)

emtjoe10 said:


> i never asked the instructor and he never told me; maybe the kid had a stoma.



Sorry, that's kind of annoying; you present an incomplete scenario that has people jumping through hoops that go nowhere.


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## feldy (Aug 30, 2010)

At this point with no other options available, just start chest compressions (compression only even if its not in your protocals, if you cant get and airway and you have such a weak pulse, then you should being doing compressions). Then call CMED and ask if there is anything else you could do. If possible allergic rxn, maybe give and epi pen jr. but only as ordered by CMED.


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## feldy (Aug 30, 2010)

btw CMED is med control.


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## emtjoe10 (Aug 30, 2010)

firetender said:


> Sorry, that's kind of annoying; you present an incomplete scenario that has people jumping through hoops that go nowhere.



I'm sorry for the scenario that was given to me. I apoligize that i was 2 weeks out of school when this annoying scenario was given to me. Trust me if i had the choice i would have had a different scenario, maybe i wouldn't have failed it. I'm looking for a possible solution, if say it were to happen. Its the medical field isn't it? Anything can happen. correct? But appreciate your feedback.


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## emtjoe10 (Aug 30, 2010)

feldy said:


> btw CMED is med control.



yea thanks i'm well aware of that.


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## feldy (Aug 30, 2010)

sry...not everyone calls it that.

Going back to the scenari...would giving an epi pen be acceptable (if given the green light)?


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## emtjoe10 (Aug 30, 2010)

feldy said:


> sry...not everyone calls it that.
> 
> Going back to the scenari...would giving an epi pen be acceptable (if given the green light)?



well i see your from mass i am also so cmed is how i learned it. did some bmc trauma work also. Local cmed


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## feldy (Aug 31, 2010)

nice...who do u work for now?


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## emtjoe10 (Aug 31, 2010)

As of right now i am not with a company i am in the process of joining atlantic, as long as everything goes smoothly. As far as i know, no one is really looking for basics right now im having a hard time finding a company hiring


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## feldy (Aug 31, 2010)

Yeah...i had a hard time finding a job as a basic too especially just for the summer, i think Lawrence General Emergency has a few ER Tech/attendant positions open, if Atlantic doesnt work out for you.


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## emtjoe10 (Aug 31, 2010)

feldy said:


> Yeah...i had a hard time finding a job as a basic too especially just for the summer, i think Lawrence General Emergency has a few ER Tech/attendant positions open, if Atlantic doesnt work out for you.



do they require a phlebotomy/ekg certification that you know of?


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## Sam Adams (Aug 31, 2010)

feldy said:


> btw CMED is med control.



In Mass, this is NOT correct. CMED (more correctly the CMED operator) connects you to the hospital that you get medical control from, and further requests an MD to run your orders/ requests through....


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## emtjoe10 (Aug 31, 2010)

Sam Adams said:


> In Mass, this is NOT correct. CMED (more correctly the CMED operator) connects you to the hospital that you get medical control from, and further requests an MD to run your orders/ requests through....



ok... so regardless of how the system operates, we contact cmed , we get our orders.. i know that when contacting boston cmed we go directly to boston medical center E.R. Thanks for the input..


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## feldy (Aug 31, 2010)

emtjoe10 said:


> do they require a phlebotomy/ekg certification that you know of?



I dont believe they do, they do a lot of on the job training. On the floor at least when i was there at nights there were two phlebotomists, and a paramedic who could do blood draws as well. Im not sure if the techs did draws or not but i dont think you need it. Youd have to take a course there most likely. Also they have you take some other quick course about how to use their pt. records system on the computer (everything is electronic).


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## Needajob (Nov 23, 2010)

i think the main problem is you are not suppose to perform backslaps to an unresponsive with a fbao, same as with a +1 year old and the heimlich. just cpr. i am guessing they went into cardiac arrest because the obstruction was not cleared quick enough. its probably their way of saying you messed up. i dont what else you could do, just transport as quickly as possible, continue to try to intercept with als, maybe try epinephrine if all else fails. practical assessments suck because its hard to visualize things with a dummy or imaginary patient.


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## 18G (Nov 23, 2010)

That's a pretty open-ended scenario which leaves many possibilities.

Having some sort of history and knowing what the kids was doing before being found not breathing helps. 

Some possibilities...

FBAO? Where was the kid and what was within his reach?

Toxicological... did the child ingest some of the caregivers pills left laying around? Illicit drugs perhaps kid got a hold of? Get into any chemicals?

Infectious Illness? Has child been sick? Some URI's in very young kids can alter stimulation to breathe and cause respiratory arrest. Meningitis?

Severe Electrolyte Abnormality? Recent fluid loss - vomiting, diarrhea, diaphoresis and fever? Decreased intake?

Trauma/Abuse? How were the caregivers acting? Any signs of injury? How do the eyes look? What is the general appearance of the home? Signs of head bleed?

Seizures? Seizures can lead to respiratory arrest. 

Cardiac? Rate too fast? Too slow?

At the point you were at intervention is where your focus needs to be. MAKE SURE you have a patent airway. If you do not see any chest rise at all despite head repositioning, then its safe to assume a FBAO. Get a flashlight and do a good look into the airway... and try to get an accurate history from the caregivers. 

For a one year old FBAO, technique is supposed to be CPR for an unconscious patient.


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