Friday, July 31, 2009

A Scary Sick Baby

We got called out at 12:30 yesterday afternoon for a pickup at Logan Airport. No further information except that the patient was a child coming from Saudi Arabia. The flight was scheduled to land at 2:30.

As it turned out, the aircraft landed 45 minutes late. Customs had to clear the people who were getting off. There were at least 5 people that had to be cleared through Customs and Immigration, not including the patient and his mother.

The aircraft – actually an air ambulance – had a staff of one physician and three nurses. I received report from one of the nurses, a tiny Filipino woman whose command of English was tenuous at best. A 4 month-old male who went into respiratory failure at 2 weeks of life. He was diagnosed with the following: aortic stenosis. Both hypertrophy and hypoplasty of the left ventricle. Congestive heart failure.

He was intubated and on a ventilator. Multiple drugs running through a peripheral IV and a femoral line, including Dopamine, Versed, and Morphine. And I knew none of this until we got on board the aircraft and I was able to assess this child. Mother and Father were both there; I suspect that the Father is a member of the Saudi military, though I can’t say why. Mother was wearing a head-to-toe burqa. Neither spoke English. And of all the people that were there, the only people that did were the nurse I received report from and the doctor.

The one thing that amazed me was how tiny this baby was. At 4 months of age he should have weighed more than 4.4 Kg, a little over 9 pounds.

When we got on the aircraft, we had to do a couple of things to be able to transport this baby. First, we had to move the Dopamine onto our pump. And we had to bag the baby. Getting him off and packaged was a challenge because of changing everything over.

We got a driver – turned out we needed one because I wasn’t going to be able to handle care by myself. And the mother traveled with us; we went to Children’s Hospital, to the Cardiac Intensive Care Unit.

Managing the baby during the trip wasn’t difficult in itself. However, having to deal with Oxygen saturation levels that went up and down like a roller-coaster was a challenge. Plus the mother was obviously worried about her child; even though she couldn’t speak English her concern was evident. I caught her cues and did my best to reassure her without speaking that her baby was getting the best care possible.

It took 20 minutes to get from Logan to Children’s in traffic. It another one of those rides that was incredibly long. Probably one of the longest of my life. But – the baby survived the ride, and we were able to get him to where he belonged.

And when we were done, I was tired. It was critical care transport at its best.


TOTWTYTR said...

Nice work. I'm a bit surprised that Children's didn't send their own ambulance, though. Not because you're not capable, but because they seem to like to do those complex transports themselves.

Medic(three) said...

Runs like this are the type the ones that hang on in our memories the longest. Sure, you didn't perform the initial critical interventions, but there is so much that can go wrong.

Keeping your cool is the sign that you didn't fail. These are the type of call that makes you want a little follow up info too... or not want it at all.