Case of the Month
January 2004

Infant male — shortness of breath

You and your partner are dispatched to a third party report of an ill infant. A local medical clinic originated the 911 call to report that a woman had phoned them seeking advice about her 4-month-old son. She reported that the child had a febrile illness for the last 2-3 days and this morning developed SOB and became listless. The dispatcher attempted to phone inside the home but received only a busy signal.

You arrive at the scene and are met at the door by the mother who is holding the ill infant. Immediately you begin your assessment using the pediatric triangle (appearance, work of breathing and circulation/skin signs). You immediately note the child is lethargic, pale and ventilating at an approximate rate of 60 breaths per minute. Quickly you make the determination the baby is SICK--you request a medic unit and instruct your partner to begin assisting the infant’s respirations with a bag-valve mask. Your quick secondary exam finds the infant has HR of 220 and a capillary refill time greater than 3 seconds. His lungs are quiet with bilateral wheezes and deep chest wall retractions.

Further medical history from the mother reveals the baby has had a fever, cough and poor appetite for the last few days. This morning the respiratory distress appeared to worsen and she called the medical clinic for advice which prompted the call to 911.

You and your partner continue to assist with ventilations, monitoring the infant’s heart rate and capillary refill time. You also update the medics with a quick short report of what you have found and your course of treatment. The medics arrive, intubate the infant and begin to treat the bronchospasm with several bronchodilator medications. The infant is subsequently transported to Children’s Hospital where the diagnosis of respiratory failure secondary to RSV is made. The infant is released a 3 days later after making a complete recovery.

RSV (respiratory syncytial virus) is a common life threatening infection that is most prevalent during the winter months. The infection causes destruction of the lining of the airways leading to profuse secretions and bronchoconstriction. Proper management of this illness relies heavily on the EMTs ability to: quickly make the SICK/Not SICK determination using the pediatric assessment triangle, request ALS assistance and begin aggressive oxygen therapy.