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It is 6.30am and you are the most senior Emergency Medicine Medical Practitioner on the night shift. You are alerted to a 10-week-old male who is en-route to the Emergency Department in an asystolic cardiac arrest. CPR is in progress and has been ongoing for 10 minutes. They have had 2 doses of 0.1mg/kg Adrenaline through a proximal tibial intraosseous device. Their ETA is 10 minutes.
What might you want to do to prepare?
The 10-week-old child, James, arrives with his mother and the crew give you the following hand over, with CPR ongoing:
The Paediatric on-call Consultant has been informed by the paediatric team and is on her way into the hospital. Two uniformed police officers are also in attendance and have informed the Senior Investigating Officer who will be arriving imminently.
You lead the arrest whilst the Paediatric Registrar takes a more detailed history from his mother who is present in the room.
There is obvious rigor mortis that is preventing the anaesthetist from inserting an airway and the downtime has now been over 30 minutes. The Paediatric SHO has taken a blood gas from a femoral vessel, which comes back as follows:
You decide that the resuscitation is futile. What things do you need to consider before stopping resuscitation?
The paramedic crew, ED team and paediatric team all agree that continued attempts at resuscitation are not going to lead to a successful outcome, and care is withdrawn. You document the time and begin to retrospectively write your notes.
The Paediatric Consultant-on-call is now present and begins to take a detailed history:
Which features described above are risk factors for SIDS?
You are not present for the examination, but you noted during the process of CPR:
One of the student nurses approaches you at the Nurses’ Station and ask you whether you think that it was a “cot death” or “because of abuse”.
What is the best way to approach this?