Acute onset, increased work of breathing

Treatment

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

Disposition

• Transport to regional children’s hospital

Authors:

• Elliot Williams, Paramedic Woodburn Ambulance

Editors:

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

Diagnosis

• 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