Pediatric: ALTE

[SC Bird]

Just wondering how many people have dealt with an ALTE? I encountered one yesterday while on a paramedic ride along for class.

1 yr. old male. 10 minutes after eating, pt. went limp, apneic, became cyanotic. Father began rescue breathing for pt and called 911. Arrived on scene, father handed us the kid while we were still in the truck. Pt. limp, not interacting, had shallow respirations, no increased work of breathing, pale, strong pulses. SpO2 90% on room air.

Pt. responded well to BLS airway management and oxygen. Began vigorous crying. Skin became pink. Sinus rhythm with a rate in the 140s. SpO2 100% on O2. Rectal temp 102.3*F. Pt. began to interact but would alternate. Emergent transport to closest facility.

Just curious if any of you have ever dealt with a similar situation. Pediatric pucker factor was kicking a bit on this one...

 

[VentMedic]

Great subject for a overview of some pedi topics and assessment.

ALTE can have many potential causes including central or obstructive apnea, GER, seizures, cardiac and even Munchausen syndrome by proxy.

An interesting disorder that hopefully gets diagnosed before leaving the hospital at birth but, sometimes not:
Ondine's Curse or more appropriately known as congenital central hypoventilation syndrome (CCHS).

 

[eggshen]

ALTE should be considered anytime you have a kid (birth to 1yoa, typically 6 mo or less) that has a change in color, tone, mentation or anything else that prompts caretakers to call 911.

There is not loads of info available, but what is available is-in my opinion-worth taking seriously. Up to 6% of the pediatric population has a history of ALTE. Up to 27% of SIDS vitims have a previous hx of ALTE. 50% of cases land up with some kind of dx, they range from rather benign to very serious and everything in between. The remaining 50% is idiopathic. Due to the nature of the complaint though the demographics are not solid. The most important thing to realize is to take it seriously.

Egg

 

[Melbourne MICA]

Alte

It's great to see a broad understanding a relatively obscure circumstance.

"Apparently Life Threatening Events" in Paediatric patients are well documented in the literature. The key component in all of this for ambos beyond understanding the various aetiology's and pathologies is that the events are reported by one or more of the parents on observation.

Frequently problems don't seem apparent when the ambulance attends particularly in babies and this has given rise to unfortunate presumptions of a child with a minor aliment who does not require any immediate care or just over anxious and protective parents.

The "apparent" bit of the acronym highlights the intuition and observations of the parents who believe that something occurred -it may be something as small as a short period where he or she thought the baby stopped breathing. Changes in colour are also commonly reported.

The most important thing is to take the parents seriously when they express concerns - the literature has made it abundantly clear that 9 times out of ten they are right.

So the combination of an apparently well child but sceptical parents with a good story means transport to hospital for further examination.

MM

 

[Melbourne MICA]

It's great to see a broad understanding a relatively obscure circumstance.

"Apparently Life Threatening Events" in Paediatric patients are well documented in the literature. The key component in all of this for ambos beyond understanding the various aetiology's and pathologies is that the events are reported by one or more of the parents on observation.

Frequently problems don't seem apparent when the ambulance attends particularly in babies and this has given rise to unfortunate presumptions of a child with a minor aliment who does not require any immediate care or just over anxious and protective parents.

The "apparent" bit of the acronym highlights the intuition and observations of the parents who believe that something occurred -it may be something as small as a short period where he or she thought the baby stopped breathing. Changes in colour are also commonly reported.

The most important thing is to take the parents seriously when they express concerns - the literature has made it abundantly clear that 9 times out of ten they are right.

So the combination of an apparently well child but sceptical parents with a good story means transport to hospital for further examination.

MM

PS My understanding is that "A.L.T.E." does not describe a particular pathology or syndrome but rather the description of a medical event witnessed by the parent/s involving a sign or collections of clinical signs that seemed sufficiently worrying and out of place to them to call an ambulance.

It typically involves very young children and babies who obviously cannot verbalise their complaint.

In the medical chart at hospital it would be usually notated as, "Mrs x observed an ALTE involving a period of apneoa and cyanosis in her 10week old male baby lasting approximately sixty seconds....." etc.