Collapse in children

Question 1

The child’s brain requires two vital factors:

Answer 1

oxygen and glucose.

Question 2

Initial basic management

Answer 2

Lie child on side.

Suck out mouth and nasopharynx.

Intubate or ventilate (if necessary).

Give oxygen 8–10 L/min by mask.

Pass a nasogastric tube (lubricated):

• 0–3 yrs 12 PG
• 4–10 yrs 14 PG

Pay attention to circulation. Give blood, Haemaccel or N saline.

Take blood for appropriate investigations.

Consider ‘blind’ administration of IV glucose.

Once endotracheal tube is in place, drugs used in paediatric CPR can be given by this route (exceptions are calcium preparations and sodium bicarbonate).

Question 3

Endotracheal tube—for respiratory arrest use uncuffed:

Answer 3

Size = age in years / 4 +4

or size of child’s little finger or nares

Question 4

If intubation difficult

Answer 4

Oral airway

Bag and mask

Consider needle cricothyroidotomy 14–16 g Jelco in caudal direction

Question 5

Basic life support

Answer 5

Chin lift so head in ‘sniffing’ position

2–5 rescue breaths (RBs)

Chest compressions—30 to 2 RBs

• –lower 3rd sternum to ⅓ A-P chest diameter
• –100–120/min
• –2 fingers or thumbs <1 yr; heel of hand 1–8 yrs
• –2 hands > 8 years

Question 6

Pulse oximetry and oxygen saturation

Answer 6

The pulse oximeter measures arterial saturation of arterial block (SpO2).

In healthly young people SpO2 should be 97–99%.

The median value in neonates is 97%, in young children 98% and adults 98%.

A level < 95% and especially < 92% is a serious concern.