No Idea...

Had a call last shift and like many calls that I run, I have no idea what was going on...

The call was for a respiratory distress on a child. We get to the daycare center where the call was and go inside expecting to see a child in distress. Instead we see a smiling, laughing, playing kid. The workers at the facility said that the little patient had turned blue. Now, when you get a call for respiratory distress call and the people on scene say the patient was blue, you expect the face, or at least the lips and maybe nail beds to be blue right? Wrong.

They said that the patient's feet were blue, well actually everything from the knee down. I asked if he was having trouble breathing? No. Wheezing? No. Crying? No. Did it seem as though he was in pain? No. Acting different than normal? No. What was he doing before, during and after? Nothing, just playing. Hmmm... So he wasn't acting like there was anything wrong with him at all? No. They just noticed that his legs were blue.

The patients legs and feet were fine when we got there. The first responders who got there before we did said that the kids feet were a bit cyanotic, but quickly returned to normal. I continue my questioning...

Any past medical history, medications, allergies? No to all. Last meal and what was it? Lunch, mac-n-cheese and apple juice, same as every Tuesday. Did you change the brand of food, drink anything? No. Any new people, toys, carpet, anything new at all? With a weird look, they answer no to all. Well, I'm completely stumped at this point. Either they don't know this child's complete medical history, or they are hiding something to try to keep themselves out of trouble. The patient is too young to talk to me, so I can't ask him any questions. But my partner has been playing with him and checking him over. She tells me that the kid seems fine, nothing wrong that she can see. Vitals are fine, cap refill is good, lungs sounds good, neuro check is good and he seems to be acting like a kid his age should act.

Then the grandmother shows up and I find out that she is the child's primary caregiver. She tells us that the history is slightly skewed from what we were told. The patient was a preemie, and only 2 pounds when born. But the kid is 16 months old. I ask her if he had any medical problems? No, none at all, his doctor said he was the picture of health. I ask if there was a reason that he was a preemie? She darts her eyes away from me. I tell her that I need to know if I am to make an informed decision about her grandson. She leans in and tells me that the child's mother was a meth addict. I ask her all the same questions that I asked the staff and get the same response. No other history, and nothing new around the child.

I tell her that he seems to be fine now. And that, according to the staff, the child displayed no other symptoms during the episode. I tell her that if it was my child that I would want this to be checked out by a physician, at the very least, his regular doctor.

She doesn't want him to go to the ED, nor be transported by us. But says that she will call the doctor and see if he can be seen today. She signs the refusal and we leave.

I have no idea what would cause this. My first thought was cardiac. But if it was his heart, I'd think it would have systemic symptoms. At least it would have involved his other extremities, not just his legs. My other thought is maybe a congenital defect that hasn't been found yet. Maybe some kind of peripheral vascular defect in his legs. Maybe it was some sort of arterial spasm. I've never heard of it in a kid, nor just in the legs. But who knows? I'm just a paramedic...

BRM