AssessmentandTreatmentof theinfant/childwithsignsoflife

(Assuming (A i youarei inah health lthf facility ilit andthereisnotrauma)

Objectives tolearnhowtomake immediatedecisions

Safe?(Stimulate)Shoutforhelp?Setting? Airway
Doesitneedclearing/support?

Breathing
Is I oxygenrequired? i d?(R (Rarely l b bronchodilators) h dil )

Circulation
Isinterventionrequired?(Fluids/blood)

Disability
Isdextroserequired q

TheSsinaseriously yillchild
Safety y
gloves/sharpsetc

Stimulate
IfalertyouDONOTneedtostimulate

Shout
ifthechildlooksseriouslyillgethelp

Setting
Areyouinthebestpartofthehospitaltowork Isfurtherassessmentbestonabed/couchorin thecaretaker caretakers sarms?

Airway
Ifalert
Listenfornoisybreathing Stridor/obstruction/foreignbody?

Ifnot talert l tthe th i infant f t/child hildshould h ldb beona couchorbedso

Lookinthemouth anyobviousobstruction? Airwaypositioningorsupportneeded?

Example airwayopeningtoimprovethe effectivenessofbreathing

I Improve b breathing thi t toprevent tcollapse ll

Severe Respiratory Disease
The child with considerably increased work of breathing needs oxygen to prevent deterioration deterioration. The exhausted child - attention to airway, y, high g concentration of oxygen, propping up, stop feeds (iv fluids), minimal handling.

R Respiratory i F Failure il

Cardiorespiratory C di i t Failure Cardiorespiratory Arrest

Rapidlyassessbreathing
CentralCyanosis? y Respiratoryrate*:
VeryFast?

Respiratory i Effort ff
Grunting? Headnodding g/bobbing? g Indrawing? Deep/acidoticbreathing? (Symmetricalmovement?)

Wheeze Wasthisinfant/childalert?
* NB very slow breathing or gasping may require BVM ventilation

Isoxygenneeded?
CentralCyanosis y ? Respiratoryrate: VeryFast? RespiratoryEffort Grunting? Headnodding/bobbing? Indrawing? I d i ? Deep/acidoticbreathing? (Symmetricalmovement?) Wheeze? checkifothersignsofsevere respiratorydistress Absolute i di i for indications f oxygenina seriouslyillchild beforeproceeding tocomplete examination

Isoxygenneeded?
CentralCyanosis? Respiratoryrate: VeryFast? Respiratory p yEffort Grunting? Headnodding/bobbing? Indrawing? Deep/acidoticbreathing? (Symmetricalmovement?) Wheeze? checkifothersigns ofsevererespiratorydistress 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

AdministeringOxygen?

Nasal Catheter / Nasal prong ~ 30 - 35% oxygen. Little risk

Naso-pharyngeal Catheter ~ 40-45% oxygen . Modest risk

Newborn,0.5L/min, Infant/Child,1 2L/min

AdministeringOxygen?

Mask, 50-60% oxygen. Needs 5-6 L/min oxygen flow Poorly tolerated by infants

Mask with reservoir bag, 80 - 90 % oxygen. Needs 10-15 L/min oxygen yg flow Poorly tolerated by infants

Improvingcirculationtoprevent collapse:
The most common causes of circulatory failure in Africa? Dehydration Anaemia

PathwaystoCardiorespiratoryArrestin Children
The child with cold hands, rapid pulse, severe dehydration or severe anaemia with respiratory distress The child with cold limbs, a weak pulse pulse, cap refill >3s >3s, and AVPU<A

Compensated Circulatory Failure

De-compensated C Circulatory Failure

Cardiorespiratory C di i t Failure Cardiorespiratory Arrest

RapidAssessmentofCirculation
Iftherearesignsoflifethereisapulse
Pulse Estimatetheheartrateatalargepulse
Veryfast?(>160bpm) Tooslow?( (<80bpm) p )

Canyoufeelaperipheralpulse?
Isitweak?

Arethehands/feetcold?
Howfarcentrally yistheskincold( (temperature p g gradient)? )

CapillaryRefillingTime?(>3secs) p Isthereseverepallor?

IdentifyingShock. Shock
Shocked Emergencycare Weakorabsent >3secs Veryfastorslow Coldlimbs Reduced

Peripheralpulse Capillaryrefilling Pulserate Skintemperature ConsciousLevel

Criticalsignin diagnosisofshock

Ifthereisseverepallorandshockorderbloodimmediately

D compensated De t dcirculatory i l t failure f il =Shock Management g 1.

Commonestcauseislowcirculatingvolume sotheaimoftreatmentisto:
Restorecirculating l volume l Improvetissueandvitalorganperfusion

Sh k No Shock N malnutrition. l t iti

A&B&Oxygenthen..... Bolusfluids Intraosseousneedle 20mls/kg gasfastasp possible (within15minutessouse syringeifnecessary) Ifnoimprovement i tonre assessmentrepeat. BloodNOWifseverepallor

Treatmentofhypovolaemicshock
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?

Summary
Gethelp Airway
Look, L k clear, l position iti

Breathing
BVMventilationoroxygen?

Circulation
Fluids/blood?