1. Jay Shetty Clinical Lecturer in Child Health
Acutely Unwell Child
Jay Shetty
Clinical Lecturer in Child Health

2. Unwell Child
Different Physiology, anatomy and aetiology compared to adults.
Approach for resuscitation and treatment are different
Common causes of acute illness in children

3. Aetiology of Cardiac Arrest in Children
Respiratory Obstruction
Respiratory Depression
Fluid Maldistribution
Fluid Loss
Foreign Body
Asthma
Croup
Convulsions Poisoning
Raised ICP
Sepsis
Anaphylaxis
Cardiac Failure
Blood Loss Burns
Vomiting
Respiratory Failure
Circulatory Failure
Cardiac Arrest

4. Age [Years]
Heart Rate
Respiratory rate
Systolic Blood Pressure [mmHg]
<1
30-40
70-90
1-2
25-35
80-95
2-5
95-140
25-30
80-100
5-12
80-120
20-25
90-110
>12
60-100
15-20

5. Systematic Approach
Airway
Breathing
Circulation
Disability
Exposure

6. Potential Respiratory Failure
Effort
Effect
Efficacy

7. Effort of Breathing Recession Respiratory rate Accessory muscle use
Nasal flare
Child’s position
Sounds
Inspiratory stridor
Expiratory wheeze
Grunting

8. Efficacy of Breathing
Chest Expansion
Air Entry
Saturations

9. Effects of Breathing
Heart Rate
Skin Colour
Mental Status

10. Potential Circulatory Failure
Early Recognition of Shock
Cardiovascular Signs
Effects of Circulatory Inadequacy

11. Circulatory Signs Hypotension is a pre-terminal sign Pulse Rate
Pulse Volume
Capillary Refill
Blood Pressure
Hypotension is a pre-terminal sign

12. Effects of Circulatory Inadequacy
Respiratory Rate
Skin Temperature/Colour
Mental Status

13. Potential Central Neurological Failure
Conscious Level
Pupils
Posture

14. Conscious Level Alert Responds to Voice Responds only to Pain
Unresponsive to all stimuli
AVPU

15. Posture
Alert
Decorticate/Decerebrate Posturing

16. Summary – Rapid Assessment
Airway and Breathing
Effort
Efficacy
Effects
Circulation
Heart Rate
Capillary Refill Time
Blood Pressure
Skin Temperature
Disability
Conscious Level
Posture
Pupils

17. Common Causes Systemic Infection/Sepsis. Trauma/Burns/Overdose
CNS: Meningitis, Encephalitis, Seizures.
Respiratory: Pneumonia, Bronchiolitis, Asthma, Croup, Tracheitis, Epiglottitis.
Cardiovascular: Congenital heart disease, arrhythmias

18. Common Causes
GI: Gastroenteritis, bowel obstruction, Appendicitis, Malrotation.
Urogenital: UTI, Epididemo-orchitis, testicular torsion.
Haematological: Acute leukaemia, Anaemia.
Musculoskeletal: Osteomyelitis, Reactive arthritis
Others: Metabolic disorders, Allergy and anaphylaxis, Intoxication, Nonaccidental Injury.

19. Infection/Sepsis Commonest cause for acute illness in children
Varying presentation [rash, fever, poor feeding, lethargy, system specific symptoms]
Treatment: supportive and antimicrobial

20. Trauma RTA Trampoline, sports injuries
Type: Fractures, Head injury, abdominal injuries.
Initial approach to management is BLS with Cervical spine immobilisation.
Burns and overdose (?NAI)

21. CNS Meningitis: Bacterial and viral Encephalitis: Commonly viral
Presentations and findings vary at different age groups
Investigation includes lumbar puncture and imaging.
Supportive and Specific treatment

22. Fits, Faints and Funny turns
Febrile seizures
Epileptic attack, Status epilepticus
Vasovagal episode, Reflex anoxic seizures
Breath holding attacks
Behavioural episodes
Arrhythmias

23. CVS Cyanotic Heart disease present early in life
Bacterial endocarditis is a severe infection
Heart murmurs
Arrhythmias are rare in children, Supraventricular tachycardia is the commonest.

24. GI/Urogenital
Viral gastroenteritis is a common illness and can lead to severe dehydration.
Congenital pyloric stenosis, Volvulus, Intussusceptions and malrotation are common causes of GI obstructions in children
Appendicitis is the most common acute abdominal condition
UTI’s are common in children

25. Common Causes Systemic Infection/Sepsis. Trauma/Burns/Overdose
CNS: Meningitis, Encephalitis, Seizures.
Respiratory: Pneumonia, Bronchiolitis, Asthma, Croup, Tracheitis, Epiglottitis.
Cardiovascular: Congenital heart disease, arrhythmias

26. Common Causes
GI: Gastroenteritis, bowel obstruction, Appendicitis, Malrotation, Hepatitis.
Urogenital: UTI, Epididemo-orchitis, testicular torsion.
Haematological: Acute leukaemia, Anaemia.
Musculoskeletal: Osteomyelitis, Reactive arthritis
Others: Metabolic disorders, Allergy and anaphylaxis, Intoxication, Nonaccidental Injury.

27. Shock
Inadequate tissue perfusion resulting in impaired cellular respiration inadequate supply of nutrients to tissues -inadequate removal of tissue wastes
Failure of circulatory function [Heart, Blood, Blood vessels]

28. Shock
Cardiogenic [arrhythmia, cardiomyopathy, valvular heart disease, contusion]
Hypovolemic [ haemorrhage, GE, gut obstruction, Burns, Peritonitis]
Distributive [Sepsis, Anaphylaxis, Drugs]
Obstructive [Pneumothorax, tamponade ]
Dissociative [Anaemia, CO poisoning]