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Unexpected but not unexplained: investigating a case of sudden unexpected death in infancy
  1. Peter Sidebotham
  1. Correspondence to:
    Dr Peter Sidebotham
    Division of Health in the Community, University of Warwick, Coventry CV4 7AL, UK;

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A 10 day old boy called Jordan was brought into the accident and emergency department by ambulance at 4.30 am one Sunday morning in October in a collapsed state. His mother had called for an ambulance 20 minutes earlier. When the paramedic crew arrived at the house they found a pale, lifeless infant with no pulse and no respiratory effort. They had instituted cardiopulmonary resuscitation using a bag valve and mask and continued this during the transfer to hospital. His mother accompanied him in the ambulance.

The arrest team had been alerted before arrival and was on hand in the department. The paediatric registrar made some initial preparations and requested that the on-call consultant be notified. Immediate evaluation confirmed the absence of a pulse and respiratory effort. Full cardiopulmonary resuscitation was instituted, including tracheal intubation and ventilation, and insertion of an intraosseous line with administration of adrenaline and a fluid bolus. On the cardiac monitor the ECG showed a flat trace. The rectal temperature was 35.1°C. A BM stick taken at insertion of an intravenous line showed a blood sugar concentration of 2.0 mmol/l. There was insufficient blood for blood gas analysis or other investigations, but the syringe was flushed with medium from a blood culture bottle. The mother, and shortly after the maternal grandmother, were present in the resuscitation room with the staff nurse assigned to support them.

Since the team had received a brief warning of the emergency, they had been able to make some preparations with the allocation of roles and the preparation of appropriate drugs and equipment. All the team members had attended paediatric life support training and this facilitated a good team approach and a prompt, appropriate, and un-panicked resuscitation. This included the designation of a nurse to support the mother and grandmother. This nurse …

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  • This case is based on experience from several cases. Details have been altered to ensure patient anonymity