Analysis of Causes
That Led to Baby Robert Benjamin Quirello’s Respiratory Arrest and
Death in
August of 2000
Ph.D., DABT,
DABVT
Toxicologist
& Pathologist
Toxi-Health
International
Phone: (707)
678-4484
Fax: (707)
678-8505
maalbayati@toxi-health.com
http://www.toxi-health.com
Table of Contents
Title Page…………………………………………………………………………………1
Table of Contents………………………………………………………………………...2
List of Tables………………………………………………………………………….….4
During Her Pregnancy With Robert and After Delivery……………………………12
I-A.
I-B.
I-C.
Section II. Review of Robert Quirello’s
Medical Records From
His Birth on March
22nd to
II-B.
Robert’s symptoms induced by his treatment with
corticosteroid…………………………………………………………………14
II-B3. Excessive weight gain…………………………………………………….15
II-B4. Muscle weakness…………………………………………………………16
II-B5. Vision
problems…………………………………………………………..17
II-C.
Vaccines given to Baby Robert and his thymic atrophy………………………..17
II-D. Adverse reactions to vaccines given to Baby Robert…………………………..19
Section III. Review of Robert Quirello’s
Medical
Records During His
Hospitalization on August 2nd Through 10th,
2000………………………22
III-A. Case history and
treatments given by the
emergency
teams on August 2nd……………………………………………………22
III-A1.
History given by Brian Herlihy………………………………..22
III-A2.
Treatment given by the emergency teams……………………..23
III-B.
Robert’s symptoms and treatments given at Shands
Hospital on 8/2-10/2000……………………….………………………24
III-B1.
Treatment at the emergency room……………………………….24
III-B2.
Head and neck region CT scan results
taken on August 2nd through August 4th …………………….…...24
III-B3. Robert’s symptoms and treatment given
at the PICU on the morning of August 2nd……………………….25
III-B5. Baby Robert’s metabolic and hematology
values during his hospitalization…………………………………27
Section IV. Review of
the Medical Examiner’s Autopsy Findings and Pathology
Reports…………………………………………………………….………33
IV-F. Robert’s spleen weight appeared less
than
normal………………………..37
IV-G.
Inadequate examination of the heart……………………………………..37
Section V. Analysis of Clinical Events and
Causes That
Led to Baby Robert’s
Respiratory Arrest and Death……………………………………………...38
V-A.
Events that led to Robert’s respiratory arrest on
V-C2. The release of high levels of endogenous corticosteroid
also causes neurological problems………………………………..43
V-C3. Abnormal changes in the nervous system caused by
corticosteroid can also be reproduced in experimental animals….44
V-E. Corticosteroid causes hypertension, diabetes,
and other systemic problems………………………………………..……..46
V-F. Corticosteroid increases the risk for
infections in infants………………….48
V-G. Corticosteroid causes retinopathy and other vision problems in
patients……………………………………………………………………..49
Section VI. Brian
Herlihy’s Jury Trial and Analysis of
the Evidence Presented….50
VI-A. Analysis
of the testimonies given by the State’s expert witnesses………51
References……………………………………………………………………………….57
Table 1.
Table 2. Robert’s growth measurements from birth
through
Table 3. Robert’s vaccination history……………………………………………………18
Table 4. Compositions of vaccines administered to Baby Robert
two weeks prior to his respiratory arrest and seizure…………………………...18
Table 5. Baby Robert’s vital signs between 0938
and 0958 on
Table 6. Indicators of myocardial infarction in Baby Robert’s blood…..………………27
Table 7. Baby Robert’s serum chemistry values on August 2nd and August 3rd…..…….28
Table 8. Baby Robert’s metabolic parameters measured following his
respiratory arrest……………………………………………………………….28
Table 9. Baby Robert’s
hematology
parameters measured following his
respiratory arrest……………………………………………………………….29
Table 10. Partial list of medications given to
Baby Robert in
SUMMARY
Brian Herlihy is a
32-year-old, white
man. He was accused
of, and arrested for killing Baby Robert Benjamin Quirello by vigorous
shaking
in August of 2000. Robert was a four and a half month-old infant, who
suffered
from respiratory arrest while at Brian’s apartment on the morning of
Brian
Herlihy’s jury trial was held in the Eighth Judicial Circuit in
In
addition, the State alleged that Baby Robert was never lethargic or
anxious
from the time of his birth until the morning of
Brian Herlihy and his family requested that I evaluate the medical evidence in Baby Robert’s case in order to find the factual cause(s) that led to Robert’s respiratory arrest and death in August of 2000. I evaluated Robert’s case by reviewing: The medical records of the mother during her pregnancy with him, Robert’s medical records, autopsy report, adverse reactions to medications and vaccines given to Robert, trial documents and testimonies of expert witnesses, and the medical literature pertinent to this case. I used differential diagnosis to evaluate the contribution of agents relevant to this case and the possible synergistic actions among agents in causing Robert’s respiratory arrest, bleeding in the subdural space and retina, pathologic changes in the brain and other tissues, and his death.
I present my review of the mother’s medical records during her pregnancy with Robert in Section I. Section II contains a review and analysis of Baby Robert’s medical records from birth on March 22nd, 2000 up until the time of his respiratory arrest on August 2nd, 2000. I also elaborate upon and explain the adverse reactions to vaccines given to Robert in this section. In Section III, I illustrate the clinical events that occurred during Robert’s eight-day stay in the hospitals following his respiratory arrest, and my analysis of these events.
Furthermore, my review and analysis of the medical examiner’s autopsy report are presented in Section IV. In Section V, I define the pathogenesis of Robert’s illnesses and their contributions to his respiratory arrest. I also describe adverse reactions to corticosteroids in infants. My review and analysis of the testimonies given by the State’s expert witnesses are presented in Section VI. Section VII contains my conclusions and recommendations.
Robert’s mother,
Crystal Dawn
Quirello was involved in a serious car accident on
Robert’s mother was
treated with
betamethasone (corticosteroid) during the last week of her pregnancy
and due to
this treatment Robert was exposed to corticosteroid in utero. It seems
that
Baby Robert suffered from serious health problems that resulted from his exposure to corticosteroid in utero and after birth. These include: gastrointestinal disturbance and reduction in food intake, polyurea, excessive weight gain, myopathy, neurological problems, brain atrophy, chronic subdural and retinal hemorrhage, vision problems, atrophy of the thymus, diabetes, and sinus and ear infections. These symptoms and lesions have been reported in infants treated with corticosteroids as I describe in Section V. However, none of the physicians who evaluated this case ever addressed this issue.
The vaccines given to Robert increased his susceptibility to infections. The baby suffered from sinus and ear infections as shown by his cerebral CT scans taken on August 2nd. Also, DTP vaccines have been known to increase children’s risk of developing neurological disorders, such as encephalopathy or complicated convulsion(s).
Baby Robert suffered
from respiratory
arrest on August 2nd, 2000 between 0920 and 0935 and the
events that
led to his respiratory arrest can be explained as follows: 1) Baby
Robert
suffered from a seizure prior to 0935 and his seizure resulted from a
neurological problem and brain atrophy caused by his prenatal and
postnatal
treatment with corticosteroids. In addition, the vaccines received on
Baby Robert suffered from respiratory arrest for at least 60 minutes and that led to severe anoxia, which caused brain and cardiac damage. In addition, the baby suffered from a chronic subdural bleed and retinal bleed as a result of his treatment with corticosteroid. Corticosteroid given at high doses induces diabetes, hypertension, brain atrophy, and increases capillary fragility and abnormal vascular growth in the retina. Glucocorticoid causes hypertension and cardiovascular disease due to its capacity to promote sodium retention and increase blood pressure.
The cerebral CT scan
taken on
The retinal bleed and other retinal vascular changes observed by Dr. Lawrence Levine on August 2nd can be explained by Robert’s treatment with corticosteroid and diabetes. These conditions have been known to cause retinopathy and retinal hemorrhage as described in Section V.
The medical examiner
and the
State’s expert witnesses alleged that Baby Robert’s respiratory arrest,
neurological damage, and death were caused by violent shaking while he
was at
Brian Herlihy’s apartment prior to 0937 on
Review of the medical
evidence in
this case revealed that some of these physicians were aware that Baby
Robert
was suffering from chronic health conditions such as a chronic subdural
bleed,
brain atrophy, and sinus and ear infections. However, they did not make
any
attempt to investigate the links between the baby’s chronic illnesses
and his
respiratory arrest on the morning of
1) The emergency teams, several physicians, and the medical examiner examined the baby on August 2nd through August 10th and they did not find any sign of injuries on the baby’s head or body that was caused by trauma or abuse.
2) The four cerebral CT scans taken from August 2nd through August 4th indicated that Baby Robert was suffering from a chronic subdural bleed. However, none of the physicians who testified for the State ever investigated the causes of the bleed. Furthermore, the medical examiner did not take a sample from the dura to be examined under the microscope in order to date the bleed. The data described in Section V of this report shows that prenatal and postnatal treatments of infants with corticosteroid have caused hypertension, hyperatrophic cardiomyopathy, encephalopathy, and an increase in capillary fragility; these conditions can lead to subdural bleeding. Robert had been treated with corticosteroid.
It
has been
reported that premature infants treated with dexamethasone exhibited a
30%
reduction in total cerebral tissue volume when compared to both control
term
infants and premature infants not treated with dexamethasone.
Furthermore, dexamethasone
administered postnatally to infants has demonstrated increased risk of
neurologic impairment, neurodevelopmental disability, and the rate of
cerebral
palsy in preterm infants and later in survivors. Baby
Robert was treated with high therapeutic doses of
corticosteroid as indicated by the severity of his thymic atrophy.
5) Dr. John Hellrung, Baby Robert’s pediatrician stated during Brian’s trial that the baby was normal. However, his examinations showed that the baby suffered from excessive weight gain, polyurea, muscle weakness in the neck region, neurological and possible vision problems. The baby had poor head and neck control, decreased muscle tone in the shoulders and neck, and tight hip flexors. In addition, the baby’s tracking with his eyes was not consistent following an object more than a hundred degrees. These symptoms have been reported in infants treated with corticosteroid.
6) Dr. Hamilton, the medical examiner found that the weight of Robert’s thymus was 4 grams, which is about 20% of normal. However, he stated that Robert’s thymus was normal. The average thymus weight (g) in a white infant male at Robert’s age (4-1/2-month old) is expected to be about 22.5g. The treatment with corticosteroid causes immune depression as measured by the reduction in the size and the functions of the lymphoid tissues. It is clear that the medical examiner overlooked an extremely important biological indicator that showed Baby Robert was suffering from severe adverse reactions to corticosteroid.
The
extensive medical evidence presented in this report clearly shows that
Baby
Robert died as a result of adverse reactions to corticosteroid and
vaccines.
Brian Herlihy is innocent. The evidence also shows that Brian was
wrongly
convicted and imprisoned as a consequence of sloppy and incomplete
medical
investigations. I believe that the state of
The objective
of the State and physicians should be to focus on determining the
factual causes
that lead to the illness or death of a child so that they can prevent
such
problems from happening to other children. Accusing innocent people of
abusing
and killing children based on a faulty theory that has no medical or
scientific
evidence to support its claims will not prevent the death of other
children by
vaccines and adverse reactions to medications. However, it certainly
places
innocent people in prison and causes great suffering. It also costs
taxpayers
huge sums of money to pay for unnecessary trials and legal fees.
I spent
approximately 280 hours evaluating the medical evidence in this case in
order
to find the factual causes of injuries and death and to write this
detailed
report. I have also evaluated three other alleged ‘Shaken Baby
Syndrome’ cases
from the
It is my hope
that the state of
Section
I. Review of Crystal
Dawn Quirello’s Medical Records During Her Pregnancy With Robert and
After
Delivery
I-A. Cystal’s health condition during her
pregnancy
Baby Robert’s mother, Crystal Dawn Quirello
is a white
female. She was 20-years old at the time of her pregnancy with Robert
in July
of 1999. She was born on
Table 1.
Date
Weeks of gestation
Weight (lb)
Pregravid
115.0
I-B.
I believe that
I-C.
Based
on blood and urine tests performed during
Micronase
(glyburide) is an oral blood-glucose-lowering drug of the sulfonylurea
class.
Glyburide
appears to lower the blood glucose acutely by stimulating the release
of
insulin from the pancreas, an effect dependent upon functioning beta
cells in
the pancreatic islets. Single dose studies with micronase tablets in
normal
subjects demonstrate significant absorption of glyburide within one
hour and it
reached a high peak level at about four hours. The blood glucose
lowering
affects generally persist for 24 hours following a single morning dose
of
micronase in non-fasting diabetic patients [5, page 2496].
Some
sulfonylurea drugs are excreted in human milk. In nursing infants, the
potential for developing hypoglycemia exists, therefore, treatment of
nursing
mothers with micronase is not recommended during the breast-feeding
period [6].
In addition, the safety of micronase in children has not yet been
established
[5].
Section
II. Review of Robert Quirello’s Medical Records From His
Birth on March 22nd to
Baby Robert was born
four weeks
premature on
Three days following
birth,
Robert’s mother noticed that the baby’s lips and the inside of his
cheeks were
yellow. He suffered from mild jaundice. The baby was breast-fed between
March
27th and
II-B.
Robert’s symptoms induced by his treatment with corticosteroid
My review of Baby Robert’s medical records revealed that he suffered from serious health problems that directly resulted from his exposure to corticosteroid in utero and after birth [1, 3]. These include:
Baby Robert had polyurea as a consequence
of his treatment with corticosteroid. On April 17th, 19th, and 26th,
2000, his
grandmother stated that she was changing wet diapers 8-10 times per
day.
Robert’s grandmother was his principle caretaker during most of his
life
because his parents were working [7]. It
is possible that the baby had diabetes at that time. On
On April 13th and 19th,
2000,
Baby Robert’s grandmother stated that the baby was spitting formula
milk
frequently and he did not have a bowel movement from April 13th
through the 17th. On June 6th, she also stated
that the
baby was feeding poorly. On July 19th, the baby was treated
with
mylocon to relieve his problem with intestinal gas. Treatment of
infants with
corticosteroid is known to cause gastrointestinal problems as described
in
Section V of this report.
II-B3. Excessive weight gain
Baby Robert gained excessive weight between April 17th and August 2nd. He gained 10 pounds and 7 ounces in 136 days as shown in Table 2. His weight at four months and twelve days was about 3.5 times his birth weight. The approximate weight gain for an infant should be one ounce per day and 2 pounds per month during the first three months of life and 1 and ¼ pound per month between three to six months of age [9]. The approximate weight gain for Baby Robert should not have been more than 7 and ½ pounds during his life.
His abnormal weight
gain was very
obvious. On April 19th, his pediatrician reported that
Robert gained
8 ounces in two days. On
The baby experienced rapid weight gain in spite of his feeding and gastrointestinal problems described above. His rapid weight gain is one of the signs of corticosteroid toxicity that was due to water and salt retention, and disturbance in fat, protein, and carbohydrate metabolism. His weight gain was not due to building muscle mass. Robert’s serum creatinine values on August 2nd and 3rd, 2000 were less than 25% of normal values and they indicated that Baby Robert was suffering from a muscle wasting problem [8]. Muscle wasting and rapid weight gain are signs of adverse reactions of treatment with high therapeutic doses of corticosteroid.
Table 2. Robert’s growth measurements from
birth
through
Date
Age
Weight
Height
Head
Months
Inches Circumference
(cm)
II-B4. Muscle weakness
Baby Robert exhibited
muscle
weakness in the neck region. His doctor’s exam on
II-B5. Vision problems
On
II-C.
Vaccines given to Baby Robert and his thymic atrophy
Baby
Robert was given six vaccines on
At
autopsy, Baby Robert showed severe thymic atrophy. His thymus weight
was 4
grams, which was about 20% of normal [12]. The average thymus weight
(g) in a
white infant male at three months and six months of age were found to
be 20 and
25, respectively [13]. Baby Robert was 4-1/2-months-old and his thymus
weight
should have been approximately 22.5 g. Treatment with corticosteroid
causes
immune depression as measured by the reduction in size and function of
the
lymphoid tissues.
Table
3. Robert’s vaccination history
OPV/IPV (Oral Polio vaccine)
Hib (Haemophilus Influenzae B)
Hep B (Hepatitis B)
OPV/IPV (Oral Polio vaccine)
Hib (Haemophilus Influenzae B)
Hep B (Hepatitis B)
Table 4.
Compositions of vaccines administered to Baby Robert at two
weeks prior
to his respiratory arrest and seizure*
__________________________________________________________________
Vaccine
Compositions
__________________________________________________________________
DTaP Each dose (0.5 mL) contains 0.625 mg aluminum; 25
Diphtheria toxoid; 10 tetanus toxoid; 25 mg pertussis toxin;
25 mg filamentous hemagglutinin; 8 mg pertacin; 2.5 mg
2-phenoxyethanol; 4.5 mg sodium chloride; and 0.1 mg
formaldehyde.
Hepatitis B Each dose (0.5 mL) contains 0.25 mg aluminum;
10 mg of hepatitis B antigen; 4.5 mg sodium chloride;
25 mg thimerosal (organic mercury); 0.49 mg disodium
phosphate dihydrate; and 0.35 mg sodium dihydrogen
phosphate dihydrate.
HIB Each dose (0.5 mL of 0.4% sodium chloride solution)
contains 10 mg of purified Haemophilus capsular
polysaccharide.
OPV Each dose (0.5 mL of buffered solution) contains less than
25 mg of each of the antibiotics (streptomycin and
neomycin) and attenuated poliovirus.
*Described in the Physicians’ Desk Reference [5].
II-D. Adverse reactions to vaccines given to
Baby Robert
Serious
adverse reactions to the vaccines given to Baby Robert (Tables 3 and 4) requiring medical intervention (such as apnea
and cardiac problems) are commonly observed in preterm infants. Baby
Robert was
born four weeks premature and he was suffering from severe immune
depression as
indicated by his thymus weight measured on August 10th. Vaccination is not recommended in children
who have been treated with corticosteroids and other immunosuppressant
compounds.
Furthermore,
the authors of many well-documented studies concluded that the risk and
benefit
of vaccination in preterm infants should be evaluated prior to
administering
the vaccines. They also emphasized that preterm infants who receive
vaccines
should be monitored. The following are descriptions of several selected
studies
conducted in the
1)
Case
histories of 45 preterm babies who were vaccinated with
DTP/Hib (diphtheria, tetanus toxoids, and pertussis/Haemophilus
influenzae type
B conjugate were studied retrospectively [14]. Apparent adverse events
were
noted in 17 of 45 (37.8%) babies: 9 (20%) had major events, i.e.,
apnea,
bradycardia or oxygen desaturations, and 8 (17.8%) had minor events,
i.e.,
increased oxygen requirements, temperature instability, poor handling
and
feeding intolerance. Age at vaccination of 70 days or less was
significantly
associated with increased risk (p < 0.01). Of 27 babies vaccinated
at 70
days or less, 9 (33.3%) developed major events compared with none when
vaccinated over day 70.
The authors
concluded that vaccine-related cardiorespiratory events are relatively
common
in preterm babies. Problems were much more common when the vaccine is
administered at or before day 70. Therefore, these babies should be
monitored
post-vaccination. Baby Robert was given six vaccines at 46 days of age
and his
vaccination with these vaccines was repeated at four months of age
(Table 3).
At this time the baby was suffering from severe thymic atrophy.
2) After the
occurrence of apnea (a respiratory pause of 20 seconds) in two preterm
infants
following immunization with DTP and Hib, Sanchez et al. conducted a
prospective
surveillance of 97 preterm infants (50 girls, 47 boys) younger than 37
weeks of
gestation who were immunized with DTP (94 also received Hib at the same
time)
to assess the frequency of adverse reactions, and, in particular, the
occurrence of apnea. For each infant, data were recorded for a 3-day
period before
and after receipt of the immunization [15]. Their study showed that
apneic
episodes occurred in 34 infants (34%) after immunization. Twelve
infants (12%
of total) experienced a recurrence of apnea, and 11 (11%) had at least
a 50%
increase in the number of apneic and bradycardiac episodes (heart rate
less
than 80 beats/min) in the 72 hours following immunization. Some of
these
infants required new medical interventions for the increased episodes
[15].
3) Botham et
al. conducted a prospective study of 98 preterm infants (53 males, 45
females),
of gestational age 24-31 weeks who were immunized at approximately 2
months
postnatal age with diphtheria-tetanus-whole-cell pertussis vaccine
(DTPw). Half
the infants also received Haemophilus influenzae type b conjugate
vaccine (Hib)
simultaneously [16]. All infants were monitored for apnea and
bradycardia
during the 24-hour pre- and post-immunization periods.
The study
showed that only one infant had apnea and/or bradycardia
pre-immunization,
compared with 17 post-immunization. For 12 infants these events were
brief,
self-limiting and not associated with desaturations (oxygen saturation
<
90%). However, for five infants (30%), these events were associated
with oxygen
desaturation, and two of these infants required supplemental oxygen.
When
considering immunization for preterm infants, the benefits of early
immunization must be balanced against the risk of apnea and bradycardia
[16].
4) Slack et
al. reported that four premature infants developed apnea severe enough
to
warrant resuscitation after immunization with diphtheria, tetanus,
pertussis
(DTP), and Haemophilus influenzae B (Hib). One required intubation and
ventilation. They also reported that although apnea after immunization
are recognized
they are not well documented [17].
5) Botham et
al. conducted a prospective study of 97 preterm infants who were
immunized with
diphtheria-tetanus-pertussis to document respiratory and cardiac events
[18].
The mean gestational age at birth was 28.1 weeks (range 24-34) and the
mean age
at immunization was 80.6 days (range 44-257). They found that nineteen
(20%)
infants developed apnea or bradycardia within 24 hours of immunization.
Two
infants who developed concurrent upper respiratory tract infections
required
additional oxygen, and one of them was treated with oral theophylline.
Adverse
reactions of vaccines that were administered to Baby Robert are not
limited to
preterm infants. They have also been reported in full term infants.
Below are
brief descriptions of selective studies that describe the incidence of
illnesses associated with vaccinations in children. Some of these
studies are
described in the Physicians’ Desk Reference [5].
1)
In the
2) Systemic
adverse events occurring within 3 days following vaccination of 4,696
Italian
infants with DTP at 2, 4, and 6 months of age were recorded. These
included
fever of more than 100.4 F in 7% of total; irritability in 36.3%;
drowsiness in
34.9%; loss of appetite in 16.5%; vomiting in 5.8%; and crying for 1
hour or
more in 3.9% [5, p. 3063].
3) The
whole-cell DTP vaccine has been associated with acute encephalopathy
[5]. A
large case-control study that included children 2 to 35 months of age
that
suffered from serious neurological problems was conducted in
4) Three
hundred sixty-five infants were inoculated with Hib, and some of them
developed
systemic adverse reactions. The following adverse reactions and their
percentages occurred in two-month-old infants during the 48 hours
following
inoculation: Fever > 100.8 F (0.6%); irritability (12.6%);
drowsiness
(4.9%); diarrhea (5.2%); and vomiting (2.7%) [5, p. 2318].
5)
The database from the 1994 National Health Interview Survey (NHIS) in
the
The above
selected studies clearly show that serious health problems and even
death can
result from vaccinating infants and children, especially among
premature
infants and infants suffering from pre-existing conditions. The authors
of
these studies emphasized that premature infants should be monitored
following
the administration of vaccines. Furthermore, the Physicians’ Desk
Reference
states that vaccines should not be given to children treated with
corticosteroid compounds [5].
Fourteen days
prior to Baby Robert’s respiratory arrest on August 2nd, he
was
given six vaccines. At the time the infant was administered these
vaccines on
July 19th, he was suffering from severe immune depression as
indicated
by his thymus weight measured on
Section III. Review of Robert Quirello’s Medical Records During His
Hospitalization on August 2nd Through 10th, 2000
III-A.
Case history and treatments given by the emergency teams on August 2nd
III-A1.
History given by Brian Herlihy
Robert’s mother,
Crystal went to
Brian Herlihy’s apartment with her 4 ½ month old, Baby Robert
shortly after
0900 on
Brian fed
the baby approximately four ounces of formula milk. The mother laid the
baby on
his back between two pillows on the bed, and left the room. After about
five
minutes, Brian returned to find the infant on his back at the end of
the bed
with his nose angled towards the floor. Baby Robert’s head was lower
than his
body and his head was wedged between the mattress and the bars of the
footboard
[20]. He gently tugged on the infant in order to free his head.
The infant vomited formula milk on the floor near the bed and on the bed covering an area of about 4-6 inches in diameter. The baby was not breathing [21]. Brian left the baby on the bed and called 911 at 0935 asking for help. Brian told the person who took the 911 call that the baby was draining white fluid like formula milk from his mouth and his nose. The baby was also coughing [22]. Brian was instructed by 911 personnel to place the baby on the floor and to begin CPR. Brian then proceeded to perform mouth-to-mouth resuscitation. No chest compressions were administered.
III-A2.
Treatments given by the Emergency Teams
The
Alachua County Fire Rescue teams (EMTs) arrived on the scene at 0937
and found
the baby lying on his back on the bedroom floor. Baby Robert was
unconscious,
unresponsive, and he was not breathing. His color was ashen gray. The
baby was
throwing up white milky fluid from his mouth. They bagged the baby and
provided
him with 100% oxygen and his blood oxygen saturation came up from 84%
to 100%.
They then placed a cardiac monitor on the baby and it revealed a sinus tachycardia at the rate of 170 beats per minute. The baby had palpable pulses in all distal extremities.
In addition, the EMTs placed a line in the baby’s right tibia and gave him a 100 cc of fluid. The baby’s body weight was 6.8 kg. Brian was very upset and he stated that the baby had vomited and aspirated. The EMTs did not see any signs of struggle in the bedroom or elsewhere. No bruises or abrasions were noted on the baby’s head, trunk, flank, back or extremities [21].
A second emergency team from the Gainesville Fire Department arrived at Brian’s apartment at 0943 and also found the baby not breathing [23]. Kenneth A. Johnson, the firefighter and paramedic responsible for the EMTs, stated that the baby was pale, white and unresponsive. He removed about 10 cc of red and clear mixed liquid from the baby’s nose and mouth using a suction unit. The baby had a pulse rate of 190 per minute and sinus tachycardia [24]. Table 5 shows the baby’s vital signs during the rescue on August 2nd.
Seven minutes after arrival, the EMTs managed to improve
the baby’s condition. The baby started
to breathe on his own, but it was not sufficient to sustain his life. At 0955 the baby was placed on a backboard
and was transported to the hospital. He showed some improvement on the
way to
the hospital. His skin color became pinkish and his respiratory efforts
increased. The baby made the first audible sounds when he was wheeled
into
Table 5. Baby Robert’s vital signs between 0938
and 0958 on
--------------------------------------------------------------------------------------
Time Pulse Blood Respiration Heart condition
Pressure Rate/min.
------------------------------------------------------------------------------
0938 172 80 0 Sinus Tachycardia
0944 190 70 0 Sinus Tachycardia
0955 190 70 5 Sinus Tachycardia
0955 180 70 12 Sinus Tachycardia
0958 160 70 20 Sinus Tachycardia
III-B. Robert’s symptoms a