Recognizing a seriously ill child.

Serious Illness

Respiratory Failure Circulatory Shock CNS Failure

Respiratory rate (breaths/min) Resting pulse rate (beats/min)

Age Normal Tachypnoea Age Normal Increase with
Neonate 30 – 50 >60 <1 110 – 160 Stress,
Infants 20 – 30 >50 2–5 95 – 140 Exercise
Young children 20 – 30 >40 5 – 12 80 – 120 Fever
Older children 15 – 20 >30 >12 60 - 100 Arrhythmia

Respiratory Failure
Effort of breathing increased Efficacy of breathing impaired Effects of respiration decreased
- Nasal flaring - Chest expansion - Heart rate
- Tracheal tug - Air entry - Skin colour (cyanosis)
- Recessions : subcostal, intercostals, - Pulse oximetry : poorly - Mental status (anxious)
sternal perfused, movement, <85% in air
- High RR : know what’s normal, T
is pre-terminal
- Use of accessory muscle, SCM (head
bobs)
- Child’s position : asthma (sit *silent chest is also a pre-
forward) terminal sign.
- Extra sounds : stridor, wheeze,
grunting.
** absent in exhaustion, central resp
depression, neuromuscular disease.

Circulatory Shock
CV signs Signs of poor circulation
- Heart rate - RR
- Pulse volume - Skin temperature
- Capillary Refill : central , peripheral - Colour
- BP (very late sign, goes up then down) - Mental status
- Hypotension ( pre-terminal sign)
Distinguishing cardiac problems :
• Cyanosis despite giving oxygen
• Marked tachycardia
• Increased JVP
• Gallop rhythm/ murmur
• Enlarged liver
• Absent femoral pulses
Alert of times when there’s circulatory change :
• 7 - 10 days (PDA close)
• Within 6 weeks (VSD shunting) 1. present with fluid overload 2. poor feeding, failure to thrive
Resuscitation (a) interosseus (b) IV

CNS Failure
Conscious level Posture Pupillary signs
A - alert - decorticate - Trauma
V - voice - decerebrate (worse) - SAH
P – respond to pain - Opiates (pinpoint)
U – unresponsive to all stimuli
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