Pediatric Annals

Firm Rounds 

A 4-month-old Boy with Cardiopulmonary Arrest

Robert Listernick, MD

Abstract

This previously healthy 4-month-old boy was transferred from an outside hospital at the parents’ request for a second opinion regarding his neurologic status following cardiopulmonary arrest. Four days previously, he uneventfully received his 4-month immunizations. His father fed him formula and left to take a shower. The baby was placed in the swing while the father was in the shower. Upon returning approximately 15 minutes later, he found the boy slumped over with vomit on his face. He could not palpate a pulse. He picked the baby up and noted that he was limp and not breathing. Because he felt it was fastest for him to get to the hospital by himself, the child drove to the nearest hospital, which is a 5-minute drive. At presentation there, he was noted to be asystolic for at least 20 to 30 minutes before the reestablishment of a pulse. His initial arterial blood gas pH was 6.7. He had upper extremity tonic and clonic movements following resuscitation. He was given ceftriaxone, vancomycin, acyclovir, fosphenytoin, phenobarbital, and transferred to the intensive care unit at the outside hospital. Initial EEG and follow-up EEG 24 hours later each showed diffuse slowing. He stayed there for 8 days prior to transfer.

Abstract

This previously healthy 4-month-old boy was transferred from an outside hospital at the parents’ request for a second opinion regarding his neurologic status following cardiopulmonary arrest. Four days previously, he uneventfully received his 4-month immunizations. His father fed him formula and left to take a shower. The baby was placed in the swing while the father was in the shower. Upon returning approximately 15 minutes later, he found the boy slumped over with vomit on his face. He could not palpate a pulse. He picked the baby up and noted that he was limp and not breathing. Because he felt it was fastest for him to get to the hospital by himself, the child drove to the nearest hospital, which is a 5-minute drive. At presentation there, he was noted to be asystolic for at least 20 to 30 minutes before the reestablishment of a pulse. His initial arterial blood gas pH was 6.7. He had upper extremity tonic and clonic movements following resuscitation. He was given ceftriaxone, vancomycin, acyclovir, fosphenytoin, phenobarbital, and transferred to the intensive care unit at the outside hospital. Initial EEG and follow-up EEG 24 hours later each showed diffuse slowing. He stayed there for 8 days prior to transfer.

This previously healthy 4-month-old boy was transferred from an outside hospital at the parents’ request for a second opinion regarding his neurologic status following cardiopulmonary arrest. Four days previously, he uneventfully received his 4-month immunizations. His father fed him formula and left to take a shower. The baby was placed in the swing while the father was in the shower. Upon returning approximately 15 minutes later, he found the boy slumped over with vomit on his face. He could not palpate a pulse. He picked the baby up and noted that he was limp and not breathing. Because he felt it was fastest for him to get to the hospital by himself, the child drove to the nearest hospital, which is a 5-minute drive. At presentation there, he was noted to be asystolic for at least 20 to 30 minutes before the reestablishment of a pulse. His initial arterial blood gas pH was 6.7. He had upper extremity tonic and clonic movements following resuscitation. He was given ceftriaxone, vancomycin, acyclovir, fosphenytoin, phenobarbital, and transferred to the intensive care unit at the outside hospital. Initial EEG and follow-up EEG 24 hours later each showed diffuse slowing. He stayed there for 8 days prior to transfer.

10.3928/00904481-20090501-03

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