Recognition of the seriously ill child

• Primary assessment of airway and breathing
• Primary assessment of circulation
• Primary assessment of disability

Primary assessment of airway and breathing

Effort of breathing

• Resp rate

• 	<1 yr	30-40
  	1-5	25-35/30
  	5-12	20-25
  	12+	15-20

• Recession
• Inspiratory/expiratory noises incl grunting
• Accessory muscle use
• Nasal flaring

Exceptions:

• Exhaustion (pre-terminal)
• Decreased resp drive (RICP, poisoning)
• Neuromuscular disease

Efficacy of breathing

• Tachycardia; bradycardia (preterminal)
• Skin colour (cyanosis late + preterminal)
• Mental status

Primary assessment of circulation

Cardiovascular status

• Heart rate

• 	<1 yr	110-160
  	1-2	100-150
  	2-5	95-140
  	5-12	80-120
  	12+	60-100

• Pulse volume, capillary return (normally <2 secs)
• Blood pressure: hypotension preterminal
• Expected systolic BP=80+(age x2)

• <1 yr	70-90	Gap of 20 every age
  1-5	80-95/100	up 10 each age
  5-12	90-110	max 100 @2-5
  12+	100-120	min 100 @12+

Effects of circulatory inadequacy on other organs

• Rapid respiratory rate with increased tidal volume (acidosis)
• Skin: mottled, pale, cold
• Mental status
• Urine output: 1 mg/kg/hr (2 in infants)

Primary assessment of disability

• Conscious level:

• 	A	Alert
  	V	responds to VOICE
  	P	responds to PAIN
  	U	UNRESPONSIVE

• Posture: decorticate (flexed arms), decerebrate (extended arms)
• Pupils: dilatation, unreactivity, inequality
• Abnormal respiratory pattern
• Systemic hypertension with bradycardia (Cushing's response)=herniation of cerebellar tonsils (pre-terminal)