Today we have Team Coverage. Basically, that means we have the responsibility of transporting the Critical Care Transport Team from Children's Hospital Boston. It actually happens pretty regularly; more often than not, when I come in to work, I find out pretty early on that we have the coverage. Often enough they have their own ground ambulance that is operating, but I'm told that they don't have enough Paramedics on staff to make the truck operational.
So today it's our turn. And we got a call from them almost immediately after the shift started. Up to the Salem Hospital for a newborn with an anoxic brain injury.
We picked up the team and got underway. The two nurses, Mike and Pam, are people that I've worked with before. I've worked with a number of them since I've been in Boston, and I've been impressed by their skills and their professional demeanor. Today was no different.
We arrived at the hospital and made our way to their NICU, which has all of two incubators in it. In one of the incubators was this rather large baby boy; he was intubated, he had multiple lines in place, and he was being monitored very closely. We arrived at 0830, and he had been born at close to 0600. What I gathered from the information I was able to glean from what was going on around me (the nursing staff at Salem basically ignored me and my partner - after all, we're only "ambulance drivers") was that he got stuck in the birth canal and went into distress. When he was able to be delivered - I don't know if he was delivered by caesarian or not - he was pulseless and apeneic.
This in itself is really bad. I know I'm overstating the obvious, but this is a really bad situation for the baby. In addition, once his airway was secured, there was some meconium staining, which means he had some of his own waste products in his lungs. Also a very bad thing.
Apparently once the OB delivered him and he was found in this condition he was agressively intervened with and treated as quickly as possible. However, when we arrived and the team assessed him themselves, they found that he needed much more help. His pH was around 7.0 - he was given 15 milliequivalents of Sodium Bicarbonate by the team prior to our leaving, and it didn't improve his pH much. Also, he had a really soft blood pressure, so they started a Dopamine drip on him as well before we left. All total, he got those medications plus they started D10 as he had a low blood glucose. Finally, he hadn't voided since he was born, and that worried the doctor who was sending him as well because of the possibility of renal issues. That would make sense with respect to his poor cardiac output.
I don't know what this baby's prognosis will end up being. He was sent to Children's for a type of thermal therapy that is similar to what is done with post-resuscitation cardiac arrest patients. I don't understand the concept as it applies to anoxic brain injury in infants, so I'm simply going to have to research it and talk about it in a future post. With all of that said, I can't imagine him having a good outcome; between the inability to correct his pH and the crummy cardiac output, it sure looks like he got dealt a short hand.
Poor little guy. I really hope I'm wrong about his future.