Clinical scenario: Baby not breathing

You are asked to respond to a park for an infant in respiratory arrest

"Medic 76, respond priority one with Engine 78 to 577 Oak Blvd. This will be at Roosevelt Park, on the benches near the play structure for a report of a baby not breathing."

As you start the ambulance your partner climbs in and you begin to drive to the park approximately six minutes away. About two blocks from the incident location dispatch provides you with an update:

"Medic 76 per the caller the infant was feeding and started to cough and turn blue, she appears to be awake and breathing normally at this time. You can reduce to priority two per Engine 78 on scene."

As you pull into the parking lot your partner laughs and says: "We go on these all the time. You watch, it will be a first-time mother who doesn’t realize that babies frequently choke while eating and it isn’t a big deal!"

The fire captain introduces you to Jennifer, the patient’s mother. Jennifer states that her 11-week-old daughter Kate was breastfeeding when she started to choke and did not appear to be breathing. When Kate turned blue around the lips, Jennifer yelled for help and another mother called 911.

"Is this your first child ma’am?" your partner asks.

"Yes it is," Jennifer replies.

Your partner looks at you with raised eyebrows and continues with her assessment.

Kate presents as awake and alert with good skin signs and no increased work of breathing. Her lung sounds are clear with a respiratory rate of 48/minute. Her brachial pulse is 140/minute. A pulse oximetry sensor is placed on the patient's big toe. The reading is 98 percent.

Your partner tells the patient’s mother: "Everything looks good now, do you really want us to take her to the hospital?"

The patient’s mother looks worried and unsure of how to answer.

Think about these questions as you consider what to do next:

  • What is a possible differential diagnosis for Kate?
  • Should she be transported to the hospital? Why or why not?
  • What are a few “must not miss” diagnoses for her presentation?
  • What should her prehospital treatment be?

Post your answers below in the comments and view the clinical solution for this patient.

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