Assessment and Treatment of  the infant / child with signs of life

(Assuming (A i  you are i in a h health lth f facility ilit   and there is no trauma) 

Objectives – to learn how to make  immediate decisions
• Safe? (Stimulate) Shout for help? Setting? • Airway
– Does it need clearing / support?

• Breathing
– Is I  oxygen required? i d? (R (Rarely l  b bronchodilators) h dil )

• Circulation
– Is intervention required? (Fluids / blood)

• Disability
– Is dextrose required q

The S’s in a seriously y ill child • Safety y – gloves / sharps etc • Stimulate – If alert you DO NOT need to stimulate • Shout – if the child looks seriously ill get help • Setting – Are you in the best part of the hospital to work – Is further assessment best on a bed / couch or in  the caretaker caretaker’s s arms?   .

Airway • If alert ‐ – Listen for noisy breathing – Stridor / obstruction / foreign body? • If not t alert l t the th  i infant f t / child hild should h ld b be on a  couch or bed so – – Look in the mouth – any obvious obstruction? – Airway positioning or support needed? .

Example ‐ ‐ airway opening to improve the  effectiveness of breathing .

minimal handling. y. high g concentration of oxygen.attention to airway.I Improve  b breathing thi  t to prevent t collapse ll Severe Respiratory Disease The child with considerably increased work of breathing – needs oxygen to prevent deterioration deterioration. propping up. R Respiratory i F Failure il Cardiorespiratory C di i t Failure Cardiorespiratory Arrest . stop feeds (iv fluids). The exhausted child .

Rapidly assess breathing • Central Cyanosis? y • Respiratory rate*: – Very Fast?  • Respiratory i  Effort ff – – – – – Grunting? Head nodding g / bobbing? g Indrawing? Deep / acidotic breathing? (Symmetrical movement?) • Wheeze • Was this infant / child alert? * NB very slow breathing or gasping may require BVM ventilation .

Is oxygen needed? • Central Cyanosis y ? • Respiratory rate: – Very Fast?  • Respiratory Effort – Grunting? – Head nodding / bobbing? – Indrawing? I d i ? – Deep / acidotic breathing? – (Symmetrical movement?) • Wheeze? – check if other signs of severe  respiratory distress Absolute  i di i  for indications f   oxygen in a  seriously ill child  before proceeding  to complete  examination .

Is oxygen needed? • Central Cyanosis? • Respiratory rate: – Very Fast?  • Respiratory p y Effort – Grunting? – Head nodding / bobbing? – Indrawing? – Deep / acidotic breathing? – (Symmetrical movement?) • Wheeze? – check if other signs  of severe respiratory distress Start oxygen in a child who is not alert or who is very lethargic even if no other signs i of f severe respiratory distress before proceeding to full examination .

35% oxygen. 1 – 2 L/min .5 L/min. 0. Modest risk Newborn. Little risk Naso-pharyngeal Catheter ~ 40-45% oxygen .Administering Oxygen? Nasal Catheter / Nasal prong ~ 30 .  Infant / Child.

50-60% oxygen. 80 . Needs 10-15 L/min oxygen yg flow Poorly tolerated by infants . Needs 5-6 L/min oxygen flow Poorly tolerated by infants Mask with reservoir bag.Administering Oxygen? Mask.90 % oxygen.

Improving circulation to prevent  collapse: The most common causes of circulatory failure in Africa? • Dehydration • Anaemia .

a weak pulse pulse. and AVPU<A Compensated Circulatory Failure De-compensated C Circulatory Failure Cardiorespiratory C di i t Failure Cardiorespiratory Arrest . cap refill >3s >3s.Pathways to Cardiorespiratory Arrest in  Children The child with cold hands. severe dehydration or severe anaemia with respiratory distress The child with cold limbs. rapid pulse.

Rapid Assessment of Circulation – If there are signs of life there is a pulse • Pulse ‐ Estimate the heart rate at a large pulse • Very fast? (>160 bpm) • Too slow? ( (<80 bpm) p ) • Can you feel a peripheral pulse? • Is it weak? • Are the hands / feet cold? – How far centrally y is the skin cold ( (temperature p  g gradient)? ) • Capillary Refilling Time? (> 3secs) p • Is there severe pallor? .

Identifying Shock. Shock ‘Shocked’ – Emergency care Weak or absent > 3 secs Very fast or slow Cold limbs Reduced Peripheral pulse Capillary refilling Pulse rate Skin temperature Conscious Level Critical sign in  diagnosis of shock If there is severe pallor and shock order blood immediately .

• Commonest cause is low circulating volume  so the aim of treatment is to: – Restore circulating l  volume l – Improve tissue and vital organ perfusion .D ‐compensated De t d circulatory i l t  failure f il   = Shock – Management g  1.

. – Blood NOW if severe pallor . • Bolus fluids – Intra‐osseous needle – 20mls / kg g as fast as p possible  (within 15 minutes so use  syringe if necessary) – If no improvement i t on re‐ assessment repeat... l t iti • A & B & Oxygen then.Sh k – No Shock N  malnutrition..

Treatment of hypovolaemic shock Shock identified Airway & B Ai Breathing thi (oxygen) ( ) effectively managed Establish iv / io access Signs persist 20 mls / kg bolus of fluid (<15 mins) Re-assess ABC including clinical signs s g so of s shock oc .

Questions? .

L k  clear. l  position iti • Breathing – BVM ventilation or oxygen? • Circulation – Fluids / blood? .Summary • Get help • Airway – Look.

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