Acute onset, increased work of breathing part 2


• Supplemental oxygen: pulse oximetry increased from 91% to 99%, respiration rate dropped to 60/min


• Transport to regional children’s hospital


Elliot Williams, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Respiratory distress

Differential Diagnosis

• Pneumonia
• Congenital heart disease
• Upper respiratory infection
• Failure to thrive
• Newborn infection (sepsis, UTI, meningitis)

Patient Workup

• Vitals
• Supplemental oxygen

Key Points

• It is important to obtain birth history and prenatal history when evaluating newborns.

Editor’s Notes

It is incumbent upon the EMS professional to evaluate chest excursion as seen in the supplemental video to avoid missing significant distress. This is a truly scary case for most medics. I believe the learning objective is the assessment of what a appears initially to be a peaceful child that is acutely in trouble. I would add in the Pediatric assessment triangle – WOB is increased as shown by retractions. Mental status is depressed because she is not interactive, but circulation is good because she is pink. So she is in respiratory distress possibly progressing to respiratory failure. The color of the child may reduce the chance of a blue baby cardiac diagnosis

– David Tauber, Paramedic Program Director, Yale University

Suggested References

Pediatric pulmonary emergencies


• Gender: Female
• Age: 9 days
• Height: Not Available
• Weight: Not Available


• Temperature: Not Available
• Blood Pressure: Not Available
• Heart Rate: 147
• Respiratory Rate: 64
• Pulse Oximetry: 91%

Signs and Symptoms

Increased work of breathing; poor weight gain

History Medical

• Normal spontaneous vaginal delivery (NSVD)
• Born term

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