Emergency Medicine

Paediatric Emergencies 339

Cardiopulmonary Resuscitation

5 Commence your assessment from the first moment you see the child, while
the parent or child is giving the history or the child alone is talking. Even
infants and children unable to converse will give important non-verbal cues
about their illness or pain, such as facial expressions and posture.

6 A complete examination of every child is guided by the clinical history, but
as a standard should include:
(i) Height, weight and head circumference measurements plotted on
a percentile chart.
(ii) An oral, rectal or tympanic temperature and full vital signs.
(iii) Examination of the eardrums, mouth, throat (not if epiglottitis
suspected), chest and skin.
(iv) A urine sample for sugar, protein and microscopy.

7 Children may present with non-specific symptoms and signs. A potentially
serious illness should be suspected in any child who has:
(i) Respiratory distress, stridor, grunting or gasping respirations,
nasal flaring or a silent chest.
(ii) Pallor, reduced peripheral circulation, poor capillary refill or
cyanosis.
(iii) Altered level of consciousness, drowsiness and lethargy –
particularly the ‘floppy’ infant.
(iv) Decreased fluid intake or urine output with reduced skin turgor
and dry mucous membranes.

CARDIOPULMONARY RESUSCITATION

DIAGNOSIS

1 Signs of cardiopulmonary arrest include:
(i) Unresponsiveness to pain (coma).
(ii) Apnoea or gasping respirations.
(iii) Absent circulation.
(iv) Pallor or deep cyanosis.

2 Cardiac arrest in children is usually secondary to respiratory or circulatory
failure rather than ventricular fibrillation triggered by myocardial
ischaemia, as in adults.

3 The outcome is poor and if hypoxia, hypovolaemia and acidosis are
untreated, bradycardia progressing to asystole is inevitable.

4 Early recognition and treatment of impending respiratory or circulatory
failure is therefore essential to avoid cardiopulmonary arrest occurring in
the first place.