Procedure for Resuscitation
The chart below details the actions to undertake in the event of finding a collapsed/sick child. Each part of this chart will be covered in more detail in the rest of the session.
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Procedure for Managing Deterioration
In the event of finding a collapsed child:
Ensure your personal safety. Wear personal protective equipment, if necessary
Your first impression is important. Look at the child in general to see if they ‘look unwell’
If the child is responsive or showing signs of life (palpable pulse, breathing normally, moaning), perform an ABCDE assessment. Ensure that appropriate help is on the way and treat life-threatening problems as they are identified. After completing an initial ABCDE assessment or following an intervention, reassess the child using the ABCDE approach
If the child is unconscious, unresponsive and is not breathing normally (occasional gasps are not normal and are a sign of a cardiac arrest), commence the paediatric basic life support sequence
Select the icons to find out more information.
Airway
Assessment
Is the airway patent and maintained?
Can the patient speak?
Are there added noises?
Is there a see-saw movement of the chest and abdomen?
Management
Ensure airway is patent and maintained
Simple airway manoeuvres such as head tilt, chin lift or jaw thrusts
Consider suction, airway adjuncts, position of the patient
Oxygen via non-rebreather mask
Breathing
Assessment
Observe:
Rate and pattern
Depth of respiration
Symmetry of chest movement
Use of accessory muscles
Colour of patient
Oxygen saturation
Management
Position of patient
Consider physiotherapy and nebulisers
Oxygen via non-rebreather mask
Bag valve mask ventilation
Circulation
Assessment
Pulse
Capillary refill time
Urine output
Fluid balance
Temperature
Management
Have equipment prepared to obtain access (IV or IO)
When more advanced help arrives, take bloods and administer fluids if and when appropriate
Disability
Assessment
Conscious level using AVPU
Blood glucose level
Pain
Pupil size and reaction
Observe for signs of seizures
Management
Consider recovery position
Correct blood glucose
Control seizures
Control pain
Exposure
Assessment
Perform head-to-toe examination, front and back
Look for signs of a rash or signs of injury/bleeding
Management
Manage abnormal findings appropriately
Handover
A well-structured communication process that is simple, reliable and dependable will enable the caller to convey the important facts and urgency, and will help the recipient to plan ahead.
Two examples of handover tools include:
SBAR - Situation, Background, Assessment and Recommendation
RSVP - Reason, Story, Vital signs and Plan
The use of the SBAR or the RSVP tool enables timely communication between individuals from different clinical backgrounds and hierarchies.
Select the tabs below for more information.
Situation/Reason
Introduce yourself and check that you are speaking to the correct person
Identify the patient you are calling about (who and where)
State what you need advice about
Background/Story
Background information about the patient
Reason for admission
Relevant past medical history
Assessment/Vital Signs
Include specific observations and vital sign values based on the ABCDE approach
The early warning score is….
Recommendation/Plan
State explicitly what you want the person you are calling to do
What and by when?
Don’t forget to document the call, including date and time.
Yes - the child does have a patent airway. What should you do next? Move on to the next question.
Case Study
Question 1
You see a 4-year-old child who looks unwell. On completing an A-E assessment you find that:
A: They are crying
B: Their respiratory rate is 35, their oxygen saturations are 88% in room air and they are working hard to breathe
C: Their heart rate is 120 and their capillary refill time is 4 seconds, they also have a temperature of 38.7
D: They are alert and their blood sugar is 5.6
E: There is nothing out of the ordinary
Is their airway patent?
Yes or No
Click the picture for the answer
What actions should you take next?
Select the number to sort your choices to the correct order.
Shout for help
Administer paracetamol
Get an in-depth history from a caregiver
Administer high flow oxygen
Click the Picture to reveal if you are right.
You should:
1 - Shout for help
4- Administer high-flow oxygen
3 - Get an in-depth history from a caregiver
2- Administer paracetamol
Deterioration in children should be communicated promptly so cardiac arrest is avoided. Many Health providers will utilise a version of a paediatric early warning score (PEWS) and the guidance surrounding how you escalate your concerns will be documented in your organisations policy. If in doubt, escalate immediately to the event manager or supervisor on shift.
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