Recognising the Acutely Ill Child

Elizabeth Charnock, Angela Lee, Amanda Miller

• INTRODUCTION: THE IMPORTANCE OF EARLYRECOGNITION OF ACUTE ILLNESS IN CHILDREN KEY PRINCIPLES OF PHYSICAL ASSESSMENT Standards for assessing and measuring physiological observations Temperature Pulse and respiration Blood pressure Recording physiological observations The limitations of Early Warning Scores (EWS) The importance of parental observations CHILDREN ARE DIFFERENT FROM ADULTS Pre-terminal signs Anatomical and physiological differences between children and adults A structured approach to assessment ASSESSMENT OF AIRWAY (A) Is the airway open? Are there any added sounds which may indicate airway difficulties? Airway adjuncts ASSESSMENT OF BREATHING (B) Effort of breathing Efficacy of breathing Effects of breathing inadequacy on other organs Respiratory severity assessment Oxygen delivery adjuncts ASSESSMENT OF CIRCULATION (C) Heart rate Pulse volume Pulse rhythm Capillary refill time (CRT) and body temperature Blood pressure Recognising the shocked child Classification and causes of shock The three stages of shock Meningococcal septicaemia: signs and symptoms Recognising the dehydrated child Calculation of fluid requirements ASSESSMENT OF DISABILITY (D) Rapid assessment of disability: AVPU Posture Pupils Causes of raised intracranial pressure Signs of raised intracranial pressure Seizures ‘Don’t ever forget glucose’: DEFG Tips to promote accurate measurement and recording of neurological observations Contraindications to performing a lumbar puncture ASSESSMENT OF EXPOSURE (E) Rashes and bruising Temperature APPENDIXES1 Physiological observations: normal ranges and estimation of weight formula 2 Paediatric SBAR tool 3 Basic life support – paediatric algorithm 4 Paediatric FBAO treatment algorithm REFERENCES USEFUL WEBSITES