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The seriously ill child (Causes (Metabolic
Hypoxia, hypoglycaemia, DKA
…
The seriously ill child
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Assessment
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Traffic light
assessment
Amber
Feeding <50% normal
Pale
Difficult to wake
Reduced activity
Not responding to social cues
Signs of resp distress or shock (not BP in young
as not reliable)
Red
Minimal feeding
Mottles/cyanosed/asthen
Unable to wake
Reduced conciousness/responsiveness
Signs of respiratory/cardiovascular/neurological distress
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Causes
Metabolic
Hypoxia, hypoglycaemia, DKA
Electrolyte disturbances, IEM
Trauma
NAI, FB inhalation, pneumothorax
Intussucception, malrotation
Infection
Meningitis, encephalitis
Bronchiolitis, pneumonia, croup, epiglottitis
Gastroenteritis, appendicitis, peritonitis
UTI
Vascular
HF, arrhythmias, VTE/PE
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Paediatric life
support
Basic
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Airway
Assess for 10s (breath sounds, chest movement, air sensation)
Head tilt chin lift (neutral position for infants)
Jaw thrust if needed
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Circulation
Check for signs of life
Check pulse for 10s (brachial/femoral if <1y,
carotid/femoral if >1y)
Chest compression 15:2 (rate 100-120/min);
for infant use tips of two fingers, small child use heel of one hand, older hild use both hands)
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Advanced
Defib/monitoring
Assess rhythm
If shockable, deliver shock then 2min CPR before reassessing; give IV/IO adrenaline every 3-5min (alternate cycles)
If non-shockable, resume CPR 2 min before reassessing;
give adrenaline ASAP then every 3-5min (alternate cycles)
Assess reversible causes
4H: hypoxia, Hypovolemia, Hypothermia, Hypo-K/Hyper-K
4T: Tamponade, Tension pneumothorax, Thrombosis, Toxins