Terminology if clear and concise with rationale for clinical procedures explored clearly. Check for a technical fault a Is oxygen connected? Because of the risk of apnoea, small infants and those with severe disease should be attached to oxygen saturation and respiratory monitors. Unlike trauma which is dealt with later , illness affects systems rather than anatomical areas. The adequacy of breathing can be assessed as shown in the box. In the early 1990s asthma represented 10—20% of all acute medical admissions in children, but by 2000 hospital admission rates had declined by about 50%.
The mechanism leading to this presentation is that there is a sudden massive loss of fluid from the bowel wall into the gut lumen, causing depletion of the intravascular volume and the appearance of shock in the infant. Do not use higher doses of intravascular adrenaline in children because this may worsen outcome. It is also key that information is cascaded through the organisation and across the health service to raise awareness and prevent similar situations. The immediate management of the latter is described in Chapter 10. Maternal antibodies acquired across the placenta provide some early protection but these progressively decline during the first 6 months. Babies with critical pulmonary obstructive lesions present in the first few days of life with increasing cyanosis, breathlessness or cardiogenic shock.
They are summarised in Figure 4. Side effects include hypersalivation, tachycardia and hypertension, but previous concerns with regard to increasing intracranial pressure are no longer valid. The emphasis must be upon good quality breaths followed by effective compressions. Once the priority is allocated, the appropriate pathway of care begins. In the child who has become exhausted through increased effort of breathing, recession decreases.
The ribs lie more horizontally in infants, and therefore contribute less to chest expansion. In contrast, where shock is caused by penetrating trauma requiring definitive surgical management, maximal fluid resuscitation may be best delayed until operation, as improving perfusion without improving oxygen-carrying capacity as well results in a worse outcome. If the child is too young or frightened to give a response then he or she may cry: this is an equally adequate indication that the airway is patent. It still has a role in the child who fails to respond adequately to nebulised therapy. Inhalation of warm moist air is widely used but is of unproven benefit. If there is doubt about the position or patency of the tracheal tube replace it.
A simple algorithm can be followed in order to easily achieve this skill Pathophysiology The outcome of cardiac arrest in children is poor. They require a low threshold for rapid aggressive treatment delivered by a team with an understanding of their underlying disease. To prevent fatigue, change providers should every two minutes. Consider needle cricothyroidotomy, if unable to oxygenate by alternative means. Part V gives practical guidance on performing the procedures mentioned elsewhere in the text. Whatever the method, it is essential that the carer is sufficiently familiar with it to be able to use it quickly and accurately under pressure. Advanced Paediatric Life Support is the internationally renowned manual on emergency paediatric care, written to support the course run by the Advanced Life Support Group.
This is a late and pre-terminal sign. A line of coldness may be felt to move centrally as circulatory failure progresses. This assessment and stabilisation occurs before any illness-specific diagnostic assessment or treatment takes place. This is repeated five times unless the object causing the obstruction is expelled before then. An understanding of the contents will allow doctors, nurses and paramedics dealing with seriously ill and injured children to approach their care with confidence. Cyanosis is a late and pre-terminal sign of hypoxia. This requires engagement at both the individual level, by reporting errors, and the organisational level, investigating and feeding back the error using a systematic approach.
Chin lift in infants Figure 4. Head injuries There is often concern about giving morphine to a patient who has had a head injury and who could therefore potentially lose consciousness secondary to the head injury. This is a particularly useful sign in early septic shock, when the child may otherwise be apparently well with warm peripheries. Play can be used to do this e. The blade length should be varied according to age.
Skin Mottled, cold, pale skin peripherally indicates poor perfusion. The median duration of intubation in croup is 3 days: the younger the child, the longer intubation is usually required. Assessment Inadequacy of the circulation is recognised by the absence of a central pulse for up to 10 seconds, by the presence of a pulse at an insufficient rate and by the absence of other signs of circulation, i. If uncontrolled bleeding is shown to be unlikely during the early evaluation, in the presence of a significant head injury blood pressure should be kept at normal levels to maintain the perfusion pressure to the brain. It is important, therefore, that individuals identify themselves to the leader as they arrive and roles are agreed, allocated and understood.