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It is important to maintain a close check on all unconscious children until the EMS arrives to ensure that their breathing remains normal. Avoid any pressure on the child or infant’s chest that may impair breathing and regularly turn the unconscious child or infant over onto their opposite side to prevent pressure injuries whilst in the recovery position (i.e. every 30 minutes).
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Published May 2021. View PDF Key points In the paediatric...
- Paediatric Advanced Life Support
In managing the seriously ill or injured child and infant ....
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In managing the seriously ill or injured child and infant . Management of respiratory failure . Where it is possible to accurately measure oxygen saturations (SpO 2), start oxygen therapy if SpO 2 < 94% (or for infants or children with chronic conditions at an SpO 2 3% below known baseline).
Jan 1, 2018 · Fieselmann and colleagues reported that a respiratory rate higher than 27 breaths/minute was the most important predictor of cardiac arrest in hospital wards (2) Respiratory rates in children (3) Age. Respiratory rate (breaths per minute) <1. 30-40. 1-2. 25-35.
Child 6–12 years: 300 micrograms IM (0.3 mL) Child 6 months to 6 years: 150 micrograms IM (0.15 mL) Child <6 months: 100–150 micrograms IM (0.1–0.15 mL) The above doses are for IM injection only. Intravenous adrenaline for anaphylaxis to be given only by experienced specialists in an appropriate setting. 8
- Introduction
- General Inspection
- Hands
- Face
- Close Inspection of The Chest
- Palpation of The Chest
- Percussion of The Chest
- Auscultation
- Posterior Chest Assessment
- Final Steps
Wash your hands and don PPEif appropriate. Introduce yourself to the parents and the child, including your name and role. Confirm the child’s name and date of birth. Briefly explain what the examination will involve using patient-friendly language: “Today I’d like to perform a respiratory examination, which will involve observing your child, feelin...
Appearance and behaviour
Observe the child in their environment (e.g. waiting room, hospital bed) and take note of their appearance and behaviour: 1. Activity/alertness:note if the child appears alert and engaged, or quiet and listless. 2. Cyanosis:bluish discolouration of the skin due to poor circulation (e.g. peripheral vasoconstriction secondary to hypovolaemia) or inadequate oxygenation of the blood (e.g. right-to-left cardiac shunting). 3. Shortness of breath:may indicate underlying cardiovascular (e.g. congenit...
Sounds
Note any audible soundsas you observe the child and consider what underlying pathology they may indicate: 1. Cough with wheeze: asthma, viral-induced wheeze 2. Productive cough: lower respiratory tract infection 3. Barking cough: croup, laryngomalacia 4. Dry cough: allergies, tuberculosis 5. Hoarse voice: laryngitis 6. Hot potato voice: peritonsillar abscess 7. Acute stridor: croup, foreign body, bacterial tracheitis, epiglottitis 8. Chronic stridor: laryngomalacia, subglottic stenosis
Equipment
Observe for any equipment in the child’s immediate surroundingsand consider why this might be relevant to the respiratory system: 1. Mobility aids: neuromuscular disorder 2. Feeding tubes (NG/NJ/gastrostomy):ex-premature infant, cystic fibrosis 3. Oxygen saturation monitor or oxygen cylinder: chronic lung disease 4. Tracheostomy: upper airway obstruction – each child in the UK should have a box of emergency tracheostomy equipment (often blue/red in colour). See our tracheostomy overview guide.
The handscan provide lots of clinically relevant information and therefore a focused, structured assessment is essential.
Observe the child’s facial complexion and features, including their eyes, ears, nose, mouth and throat.
Ask the parent or child (if appropriate) to expose the child’s chest. Observe the chest, paying particular attention to the respiratory rate and work of breathing.
Palpate the apex beat
Palpate the apex beat with your fingers placed horizontallyacross the chest. In healthy individuals, it is typically located in the 5th intercostal space in the midclavicular line.
Assess chest expansion
1. Place your hands on the child’s chest, inferior to the nipples. 2. Wrap your fingers around either side of the chest. 3. Bring your thumbs together in the midline, so that they touch. 4. Observe the movement of your thumbs (in healthy individuals they should move symmetrically upwards/outwards during inspiration and symmetrically downwards/inwards during expiration). Reduced movement of one of your thumbs indicates reduced chest expansion on that side.
Percussion of the chest involves listening to the volume and pitch of percussion notes across the chest to identify underlying pathology. Correct technique is essential to generating effective percussion notes. Warn the child before beginning percussion – ‘I’m going to play your chest like a drum!’ Perform percussion gently, comparing one side to t...
Start by showing the child your stethoscope and demonstrate it on your own chest and/or on one of their toysto familiarise them with this piece of equipment. Suggest listening to their chest, making sure the stethoscope diaphragm isn’t cold prior to it making contact with the child. When auscultating the chest, it is important that you have asystem...
Assess the posterior chest including inspection, chest expansion, percussion,vocal resonance and auscultation. Allocate adequate timeto assessing the posterior aspect of the chest as this is where you are most likely to identify clinical signs.
Assess for evidence of oedema: 1. Ask the parents if the child looks puffy or swollen. 2. Inspect the limbs, sacral area and face: affected areas will depend on the age of the child and mobility status.
oung people, are trained and competent in the accurate assessment and recording of the vital signs. These should include: temperature, heart/pulse rate, respiration. including effort of breathing, oxygen saturations, blood pressure and measuring height and weight.Practitioners who assess, measure and monitor vita.
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Mar 24, 2021 · Abstract. These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
