Neonate with Refractory Hypoxemia

[Sasha]

I know most of us don't do HEMS, but I thought, with a lot of googling, this was very educational and worth reading for knowledge's sake.

Neonate with Refractory Hypoxemia
Full Article: http://www.ems1.com/columnists/paul-mazurek/articles/397342-Neonate-with-Refractory-Hypoxemia

You are called to the emergency room of a community-based hospital 50 nautical miles away for a 3-day-old male in severe respiratory distress. His birth was a spontaneous, uncomplicated normal vaginal delivery. His mother reports that she had prenatal care and has two other healthy children at home.

She stated to the emergency room staff that her baby has had trouble “latching on” when breast feeding and that the “bluish” skin tone — which birth center staff had told her was normal right after birth — had not gone away. She had an appointment with her pediatrician this afternoon, but decided to bring her baby into the emergency room when it appeared that he was having increased trouble breathing.

 

[rescue99]

When this was the situation with our oldest she her dx was (is) tetrology. 30 years ago it took me weeks to ocnvince Doc's I wasn't crazy!

 

[VentMedic]

I know most of us don't do HEMS, but I thought,

Actually you may run into this with a newborn at home. Sometimes, depending on where the baby was delivered and the medical staff, a newborn is sent home appearing to be healthy until the ductus closes a few hours or a few days later.

Luckily many of the ductal dependant lesions are now identified in utero. Some hospitals are also able to do some repairs while in utero.

 

[Sasha]

Actually you may run into this with a newborn at home. Sometimes, depending on where the baby was delivered and the medical staff, a newborn is sent home appearing to be healthy until the ductus closes a few hours or a few days later.

Luckily many of the ductal dependant lesions are now identified in utero. Some hospitals are also able to do some repairs while in utero.

Ahh, of course, you are correct, my mistake!

 

[rescue99]

Sasha,

When a mother tells me she knows something is wrong...even if I can't see it, hear it or otherwise measure what that is, I can only trust her instinct and let the ER sort it out. Thank goodness, in more than 10,000 calls there have been but a few newborn responses. I've had a few 911 but, the majority of newborn calls have been transports.
EMS is woefully under trained in PEDS because the calls are rather rare. I look forward to changing attitudes in this arena. Thanks for the article!

 

[Sasha]

Thanks for the article!

There are actually quite a few, I remember at least one of them had been posted here, previously.

http://www.ems1.com/Columnists/paul-mazurek/ <--specific author of the article

http://www.ems1.com/Columnists <---many authors with many articles!

When a mother tells me she knows something is wrong...even if I can't see it, hear it or otherwise measure what that is, I can only trust her instinct and let the ER sort it out.

Of course! That goes for all patients! You aren't with them to know what they are normally like, family tells you they are off, they are off!

 

[rescue99]

Gawd..I need to edit my posts..lol! Yes, of course Sasha.

 

[medic417]

Having delivered many in the ambulance staying current with neonate education is vital. Thanks for a good post Sasha to help keep education fresh.

 

[rescue99]

Wow, delivered "many". Where do you work that deliveries are so common? I've taken part in the delivery of 5 total with a number of close deliveries. Only 1 was a normal birth. The others were either (1) still birth or babies (3) of drug mothers. Neonate resus is something I am passionate about.

 

[medic417]

On the border. Lots of illegals want to have their babys in the USA so wait till they are in late stages of labor before requesting the ambulance.

 

[rescue99]

Nuff said!

 

[VentMedic]

Having delivered many in the ambulance staying current with neonate education is vital.

In the early days I delivered many also. Women would work full term in the fields, deliver and be back in the field the next day. We even has a county birthing clinic in the middle of nowhere with a couple of ambulances stationed there. They also did emergency runs in the area but were available to take a mother and/or baby 30 miles to a hospital capable of dealing with a more difficult situation or presentation.