Why I love to hear babies cry

Okay, so why the thoughts of the pedi-codes from my last post? This past duty, shortly after dinner time, we get punched for an unconscious one year old at a mobile home park in our second due. I’m riding in the back again, Jen is up front getting more seat time. Cat was working that night, so Kelly, a medic student who just needs to test out was riding with us for some medic time. Wayne is off like a shot down the street, as soon as we get in. This particular mobile home park is well known to us, though more for fires than EMS runs. Our engine is placed in service by the first due engine, as is common for calls for kids this young. The bottom line is, I have four on my unit, the engine coming has 5, and what is another crew of fireman going to do for a patient that is less than two feet tall?

Now, one year olds go “unconscious” for two reasons in my experience. One of course is that they are dying, either by choking, or SIDS etc, the other is the postictal phase following a febrile seizure. Fortunately the latter far outnumbers the former, but one never knows. Thinking ahead, I start to gameplan the call with Kelly. We set out who will do what for a code, and both hope for the seizure. I tell her that we are going to focus on the airway if it comes to it, and we can push drugs down the ET tube fast, and worry about that IO option later. I pull out a flip book that I keep in my BDU pants and we go over epinephrine doses quick. I have to admit, I worried about Jen if the call went that way. Not because I thought she would not do well on the call, but I was worried about her afterwards. She’s been something of a death-magnet this year (I’ll tell you later), and I know it has been hard on her at times.

We get to the entrance of the mobile home park and I look out the little window to the front, and I see someone giving the “Steal second sign”. That is, one arm pointed to where we are going, the other swinging big circles, his head flicking back and forth between our unit and the trailer ahead. We see this rather often, and it is almost never a good sign. It does make me kinda chuckle when I see it though. And if I think of rounding third and heading for home as I respond to a call, I guess it only makes sense that when watching the game on TV and I see it I picture the umpire down with the big one. So, I’m a little more tense as we head up the street, slowed by speed bumps, and lead the whole way by the third base coach. Ahead I see the trailer with the engine and a couple of police cars in front of it, and a bit of a crowd around. “Wow, the cops were fast on this one” I think as we come to a stop. The engine hasn’t radioed that CPR was in progress, so that is good, but then I see three firemen and a cop hunched over a baby that is laying unmoving and flaccid on the deck to the front of the trailer. Not good.

“Are we breathing?” I ask as I approach. I have to be honest; I’ve left Jen and Kelly behind me as I moved forward. On the one hand, bad habit as a trainer, on the other hand, it does teach aggression. Anyway, I note that the baby’s color is mostly okay, if a little blue or pale at the lips. The light is not great at night in this park, but I can see the discoloration. “Yeah, but she’s not moving” I get in reply. “OK, get her to the unit, we’ll do this there.” The deck is public, there are lots of onlookers, and somewhere is mom panicked and crying—the unit is home, my world, controlled. The light is good, the people are on my team, and it’s a mobile ER on wheels. The fireguys pick up the baby and we are headed back. I note that the baby is still totally limp as they move, but hey, breathing we can work with.

In the back, Jen gets the oxygen mask ready and I get my first real good look at the baby. She’s out alright, but starting to move some, and her color is not that bad, though not what I’d like. She’s breathing without obvious effort, and I check her lung sounds as they get the O2 going. Her lungs are clear, and her heart is thundering right along, sounds like 160 or so…just about right. (Yes I counted later, but you learn to recognize “fast enough”). She’s also really warm…a fever. Fever and this behavior is febrile seizure, or the aftermath anyway. Okay, the oxygen is on now, and life is good. With little ones oxygen fixes darn near everything, and I see that is the case here too. The color is improving rapidly, and I see the baby is moving more and more. She’s not fighting the mask, which is good for her health, but shows she’s not totally back. She’s postictal, I can ramp down a notch. I look over at Kelly, and can see by the look on her face that she’s come to the same conclusion. The firemen stick their head in and I give them the news. They ask if mom can ride, and I’m okay with it. She’s crying, and pretty worked up, but I explain that this is common, and normal, and that kids grow out of it by age 5 or so. I also told her that her baby will be okay, and while scary, she’s going to be okay. Kelly and Jen pretty much take over the call from this point, monitoring the baby, getting vitals and calling the hospital. I try to calm mom, and think about how happy I am to hear the baby start crying. I swear nothing is sweeter in the back of a medic unit than a crying baby. Crying is breathing. The transport is short and easy, and the hospital is happy to take over. The only thing a bit unusual is that mom gave baby Tylenol at 6 and it’s 8 and the fever is still up, but it happens.

After a later call, I learn that they are concerned about the baby being septic. It’s not just a flu it seems, but the seizure was just that, and they are running a battery of tests to diagnose the problem.