By James BrabenecMarch 18, 2016
FORT SILL, Okla., March 18, 2016 -- Medical professionals at Reynolds Army Community Hospital here overcame a series of challenges to save the life of a baby in respiratory distress, Feb. 16.
Dakota McGowan's regularly scheduled appointment with pediatrician Dr. Jamie Laughy turned out to be a life-threatening emergency. The 3-month-old daughter of Elizabeth and Spc. Laurence McGowan, Headquarters and Headquarters Battery, 31st Air Defense Artillery Brigade, has a congenital heart murmur and was born with a rare genetic disorder, which severely limits her immune system.
Laughy said most patients fall into one of two categories -- horses and zebras -- the healthy herd of horses compared to the rarely seen zebra with a problem that required specialized care.
"You usually hear the beats of horse hooves, but you will rarely hear a zebra," she said. "As far as I know there has never been a child who had both those conditions at once -- she's not even a zebra, she's a white elephant."
Dakota's chart for her checkup called for a weight check and two medications to boost her immune system. However, she arrived at RACH in respiratory distress with a blood-oxygen level of 65 percent instead of the normal 95-100 percent. In such cases RACH typically calls 911 and has patients transferred to a facility equipped for a higher level of care.
Laughy called the University of Oklahoma Medical Center for an immediate transfer, but the OU staff was in "divert status," meaning medical personnel, facilities or equipment were unavailable and they couldn't accept her. OU cardiologists directed the RACH physician to administer oxygen.
However, Dakota's respiratory distress got worse, as her carbon dioxide level was three times the normal level, meaning she was likely in this state for two days.
"I knew then we had to intubate her and put her on a ventilator," said Laughy, speaking of a procedure to insert a flexible tube into a patient's windpipe to establish and maintain a good airway.
"Because she was such a rare case, and she was in imminent peril, there was not enough time to wait for emergency personnel to arrive,"said Laughy, "and therefore, her best chance at survival was immediate stabilization at Reynolds."
At that point, Laughy called a Code Blue, a hospital-wide alert that indicates a patient needs immediate resuscitation. John Wells, a respiratory therapist, and Capt. Michael Means, a nurse anesthetist, promptly responded.
The team moved immediately to labor and delivery as Laughy held the baby and her accompanying oxygen, with pediatric nurses there to assist and Means ready to intubate the baby and start the ventilator.
"Knowing I had both these experts here, I knew we could do this," said Laughy.
Once Dakota was stabilized, she was sent on a medical emergency flight to a hospital in Dallas. After follow-up care there, she was then transferred back up to the University of Oklahoma where she was discharged March 2.
Doctors are waiting for her lungs to heal from pneumonia and then will determine if she is healthy enough to undergo heart surgery.
"In my opinion, that was one of the worst case scenarios that could not have happened at a better time with Doctor Laughy and all the other resources available to address that situation," said Wells.
Wells said people not familiar with emergency medical response might not have appreciated the precision from which the assembled team operated.
"That was probably one of the best run emergency Code Blue type situations I have seen in my 28 years as a respiratory therapist," he said. "It was the culmination of all the right things that needed to happen at the very worst time."