by VeronicaB, MD
A baby died today; a very small infant. One minute I’m excited by the end of my overnight shift quickly approaching, and the next I am hearing the words you never want to hear come over the radio, “En route to home for infant not breathing.” I think the whole ED staff stopped for a minute waiting for the next report.
Then we begin to organize. Prepare a room, grab the pediatric resuscitation cart, where’s the Broselow tape, get respiratory alerted. The on-coming attending arrives, and I tell him what is going on.
The next report comes over the radio, “Attempted intubation, bagging via BVM, chest compressions ongoing, no IV access. Five minutes out.” Ok. Grab the ultrasound, do we have the right sized needle for the EZ IO, call an overhead infant code.
The infant arrives. One, two, three, gently over to the gurney. Let’s take a look. Intubation attempted. Ultrasound shows no cardiac activity. Temperature is 31 rectally. The parents are hovering expectantly, holding onto each other tightly, watching our every move. The other attending and I look at each other. We know there is no hope. We try to make our attempted resuscitation last as long as possible for the sake of the parents. But soon the staff understands our motions. We take one last look with the ultrasound. Silent snow.
We turn to the parents. They have a sense of what they’re going to be told before a word is even said. They look around at us and our staff and see our eyes looking down, looking sad, tearing up and looking at them wordlessly. Cries of anguish fill the ED. The infant is gently wrapped and the parents are brought to the bedside. We file silently out to give them their last moments with their child.
I go to dictate my last patient’s chart, stopping to hug the nurse who stepped into my work area to “get it together” before heading back out to the other waiting patient in the E.D. She apologizes, and I tell her it’s ok to show her emotion. She starts to shake as tears run down both of our cheeks. She quickly recovers and steps out. I take a deep breath, dial the familiar number, and begin my dictation.
VeronicaB is an emergency medicine resident who blogs at The Central Line, the blog of the American College of Emergency Physicians. Reprinted with permission from the ACEP.
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