UTSW/BioTel EMS TRAINING BULLETIN
September 2014
EMS TB 14-002 Apparent Life Threatening Event (ALTE) (PDF Here)
Background:
- An Apparent Life-Threatening Event (ALTE) is an event that usually occurs in a child less than 1 year of age in which the child experiences an acute, unexpected change in behavior, breathing, color or tone.
- These changes generally take the form of choking or gagging, apnea, color change such as cyanosis of the lips face or extremities, limpness or muscle rigidity, or unresponsiveness.
- ALTE occurs in fewer than 1 in 1,000 children but accounts for almost 1% of all ED visits for children <1 year of age.
Prognosis:
- There are many potential causes of ALTE, including airway obstruction, pneumonia or respiratory infection, sepsis, cardiac abnormality, seizures, toxic ingestions, metabolic disorders and gastric reflux.
- ALTE is associated with a 1% risk of death.
- It is impossible to predict which patients are the ones at risk of sudden death.
- This risk persists even after a baby has been discharged from the hospital with a normal work up.
- Poor prognostic indicators include:
- More than 1 event in a 24-hour period.
- The baby requires interventions such as aggressive stimulation, rescue breaths or CPR.
- Professional pediatric organizations recommend admission and monitoring for almost all cases of ALTE; however, a definitive diagnosis is made in only 70% of cases.
Transport:
- It is impossible to determine the underlying etiology of an “ALTE” event in the field.
- Just because a child appears well at the time of evaluation, serious or life-threatening underlying pathology may still exist.
- ALL patients with ALTE require a prompt emergency physician evaluation and MUST BE TRANSPORTED to a hospital emergency department. If the parent/guardian/caretaker refuses transport, contact your EMS Supervisor and BioTel immediately.
- Mange the airway as appropriate.
- Priorities for EMS include:
- Manage any obvious life threats.
- Take a detailed history including patient color, respiratory effort, tone, eye movements and the duration of the event.
- Document vital signs and all other pertinent information.
- TRANSPORT!