Stress

Abstract

An emergency dispatch center notifies a local emergency department about a child who has fallen from a third-story window. About 15 min later, the ambulance team arrives in the resuscitation bay with a 15-month-old male. Complete spine immobilization is in place and the patient is receiving oxygen via a non-rebreathing mask. A trauma team composed of an emergency medicine (EM) resident, a surgical resident, a neurosurgical resident, an X-ray technician, and two nurses assumes care of the child. Due to an emergent situation on the ward, the anesthesiologist is unavailable to join the team. As per hospital policy for trauma codes, the EM resident assumes the role of trauma team leader. Unfortunately, both surgery and EM residents have had limited experience with pediatric trauma patients. The primary survey reveals an unresponsive patient with severe head and facial injuries. The patient is tachypneic and has weak central pulses and sluggishly reactive pupils. The paramedic reports that the child was briefly unsupervised and had fallen from a third floor window. While the surgery resident performs bag-mask ventilation, one of the nurses attempts to place a peripheral IV line, but her efforts are unsuccessful. During this period, the ECG shows two episodes of bradycardia. It is not until the second nurse suggests an intraosseous needle that the EM resident considers changing his plan.