Unresponsive child

It’s been a while since I last wrote anything but here’s one I want to get off my chest.
Warning: This is an upsetting blog.

One Saturday afternoon Tony and I were called to an address to a report of an unresponsive baby. We get a lot of calls to ‘unresponsive babies’ which turn out to be drowsy and unwell with a fever but basically ok. Scary for the parents, especially first time parents. We’re not complacent about these calls and still use the blue lights to get there as quickly as safely possible but are quite relaxed. I was driving at the time and we weren’t far from the address so it didn’t take us long to get there. I pulled up at the kerb to be met by a sobbing female. I got out of the cab and the woman pointed to the door and told us her daughter was up the stairs in the flat to the left with her partner. Tony got the first response bag out of the ambulance (this is a large rucksack which contains most equipment we need to start dealing with any emergency). I went into the building and took the stairs, Tony close behind me and we went into the flat.
A man was in the living room holding a baby. He didn’t look very concerned. As soon as I saw the baby my sense of urgency suddenly ramped up. The baby was pale and her skin had a waxy sheen. I couldn’t see any sign of her responding or breathing: she looked like the plastic mannequins we practice resuscitation on. I quickly but gently took the baby from the man, trying to be reassuring as I snatched the baby and placed her on the sofa. I stripped her baby gro off so we could assess properly. I listened to her chest and with relief could hear her heart beating and breathing. Between us we measured baby’s baseline observations. Her breathing was in range but at the low end of the range and her heartbeat was normal. Her oxygen saturation was reduced but her temperature and blood sugar were both normal and she had no rash on her body and no sign of bruising or other external physical injury. I gave baby oxygen via an oxygen mask to prevent hypoxaemia (reduced oxygen in the blood). Most worrying was her lack of responsiveness – a healthy baby does not let anyone assess them like this without crying and struggling, especially when you get the pinprick of blood from the heel to check the blood sugar. As we were assessing baby I was asking the parents for the history: what had happened prior to becoming unresponsive and any relevant medical history. Baby was normally fit and well, mum told us that she had gone for a rest leaving her partner to feed and look after baby for an hour. He told us that baby had suddenly become drowsy while feeding and he had immediately woken baby’s mum.
We carried the baby down the stairs to the ambulance, the baby in my arms connected to the oxygen cylinder in Tony’s arms. We had tried to tell the parents in a reassuring way that she was seriously ill and we needed to be as quick as possible but mum’s partner still wanted to have a cigarette before we set off for hospital. We said no!
Once on the ambulance we put the ECG on so I could monitor her heart whilst on the move. Since starting the oxygen therapy she had started to respond slightly, there were periods where she became quite distressed and agitated (this was an encouraging improvement) before settling down and quiet again. More worrying was the fact that her breathing rate was slowing. I rechecked the position of her head and rechecked the small plastic tube I had put into her mouth to keep her tongue from relaxing back and blocking her airway. As I was doing this Tony was in the cab talking to our control centre, giving them basic details to pass on to the Emergency Department of the local hospital, so they could have the paediatric team ready and waiting as we arrived. We had done a lot of assessment on scene but when I checked later we had only taken 12 minutes from arriving to leaving scene.
On the way to hospital baby stopped breathing. After rechecking her airway once more I took the bag and mask which Tony had got out ready for me before getting out to drive the ambulance (he really does think of everything!). Sealing the latex mask to her face over her mouth and nose I gently squeezed the attached bag to force oxygenated air into her lungs. After a few breaths she started to breathe for herself again.
The drive to hospital only took a few minutes. All the way there I concentrated on baby’s Airway, Breathing and Circulation. I tried to be as reassuring as possible to the parents at the same tried to convey that baby was seriously unwell but we were doing all we could for her. Mum was silent and sobbing, her partner seemed quite relaxed. We arrived and quickly removed the monitoring wires. I scooped baby up and carried into the Emergency Department resuscitation room where the paediatric team was waiting for us.
We didn’t know what the cause of the unresponsiveness was and were both puzzled by the sudden onset of the illness with no apparent warning. The next job was waiting for us as we cleared so didn’t have time to dwell. The next emergency eventually brought us back to the same hospital so after we had cleared that job we called into the resus room to ask the staff if any clues about baby had been revealed by their investigations. The consultant told us that the CT scan of baby’s head revealed a series of contusions on her brain and an intracranial bleed. The only realistic explanation for these injuries was that baby had been vigorously shaken. The police had been informed.
I am writing this some months after the event, I have not wanted to write about it any sooner. Baby survived the injury but is permanently disabled. Mum and her partner are charged with assault and waiting for their date in court. Tony and I have given our statements and will be called as witnesses.

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