General Approach to All Pediatric Patients

Apparent Life Threatening Event (ALTE)

An Apparent Life Threatening Event (ALTE), sometimes referred to as a “near-miss” SIDS, is an episode that is frightening to the observer, and involves some combination of the following:

  • Apnea
  • Color change (cyanosis, pallor, erythema, plethora)
  • Marked change in muscle tone (limpness)
  • Choking or gagging

History of an ALTE may represent serious illness, even if the infant appears entirely well by the time he or she is evaluated. The apparent well-being should not be considered evidence that a potentially life-threatening event with successful resuscitation did not occur if the clinical history indicates otherwise.

Basic Life Support

  • Assume the history given is accurate and reliable
  • Determine the severity, nature and duration of the episode
  • Obtain a medical history:
    • Known chronic diseases
    • History of preterm delivery
    • Evidence of seizure activity
    • Current or recent infections
    • Gastroesophageal reflux
    • Inappropriate mixture of formula
    • Recent trauma
    • Consider non-accidental trauma
  • Perform a thorough physical assessment that includes the general appearance, skin color, level of interaction with environment, and evidence of trauma
  • Transport to the nearest appropriate receiving facility
  • Contact with Medical Control is required prior to accepting a refusal for patients < 6 months of age