i wonder what it could be

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emtjoe10

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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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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.
 
Breath for them
 
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:
Click to expand...

Start CPR
 
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:
Click to expand...

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.
 
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.
Click to expand...

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?
 
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:
Click to expand...

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.
 
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.
 
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.
Click to expand...
 
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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.
 
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.
Click to expand...

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.
 
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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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.
 
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.
Click to expand...

forgot to mention also that protocols states no blind finger sweep
 
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.

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

Once cardiac arrest happens, compression only CPR right?
Click to expand...

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.
 
i never asked the instructor and he never told me; maybe the kid had a stoma.
 
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
 
emtjoe10 said:
i never asked the instructor and he never told me; maybe the kid had a stoma.
Click to expand...

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