Collapsed child

Question 1

Management of a collapsed child:

Answer 1

ABCDE

Question 2

Airway - RECOGNITION:

Answer 2

Assess patency - look, listen, feel
Vocalisations - crying, talking =patency
Paradoxical chest and abdo momements
Signs of airway obstruction? - foreign body visible? fully obstructed airway will be silent
Cyanosis/hypoxia = late sign

Question 3

Airway - RESPONSE:

Answer 3

Call for help is airway obstructed.
Basic airway manoeuvres - older child (head tilt chin lift), infant (neutral position), Jaw thrust
AIrway adjuncts - oropharyngeal airway, nasopharyngeal airway
Suction secretions (yankauer)
Give O2
Call anaesthetist for definitive airway management

Question 4

Breathing - RECOGNITION:

Answer 4

Effort of breathing
Efficacy of breathing
Effect on body

Question 5

B - Effort of breathing

Answer 5

Resp rate
Recessions
Accessory muscle use
Flaring nostrils
Inspiratory and expiratory noises (wheeze, stridor, crepitations)
Grunting
Posture/position

Question 6

B - Efficacy of breathing

Answer 6

Equal air entry
Percussion note
Trachea central
Gasping
Sp)2 in air
Chest movement

Question 7

B - Effect on body

Answer 7

HR
Cap refil
Consciousness level

Question 8

Breathing - RESPONSE:

Answer 8

Not breathing - ventilate with bag and mask
Give O2 15L/min via reservoir bag
Aim O2 sats 94-98%
ABG - usually venous or capillary in infants and small children
CXR

Question 9

Circulation - RECOGNITION

Answer 9

Vitals - HR, pulse volume, BP
Skin & Mucous membrane perfusion - cap refil, temp, colour
Organ perfusion - effects on breathing, mental status,urine output

Question 10

Circulation - RESPONSE

Answer 10

IV access (intraosseous needle - leg if cannula not rapidly established)
Take blood for blood gas - lactate, ionised calcium, glucose, FBC, renal and liver function, CRP, blood culture, cross-match &coag
12-lead ECG
Fluid bolus (20mls/kg) and assess response

Question 11

Disability - RECOGNITION

Answer 11

Patient response: AVPU
Pupils - size and reaction to light
Posture
Blood glucose
Evidence of seizure

Question 12

Disability - RESPONSE

Answer 12

Protect airway
Endotracheal tube if GCS less than or equal to 8 (call anaesthetic help)
Recovery position if airway not protected
Give glucose if hypoglycaemia (glucose <4mmol/L)
Treat seizure with benzodiazepines

Question 13

Exposure - RECOGNITION

Answer 13

Expose the patient - assess for injuries and signs of infections and bleeding
Check temps and review physiological markers
Full Hx and examination
Drug & fluid chart review
Investigation results

Question 14

Exposure - RESPONSE

Answer 14

Senior/expert medical advice
Management plan
Documentation
Communication (SBARR)
Organise transfer to High Dependency Unit (HDU)/ ICU