Emergency Medicine

Paediatric Emergencies 347

Breathless Child

11 When to stop

The senior emergency department (ED) physician or paediatric doctor will

decide at which point further resuscitation attempts are futile, usually after at

least 20 min of failed resuscitation. He or she will also be responsible for the

distressing duty of telling the parents, who may be present and watching.

12 Formal debrief

The resuscitation of a child is a highly emotional experience. It is important

to set aside time to enable any concerns to be expressed, and for the resusci-

tation team to reflect on the clinical and psychological details in a supportive

environment.

BREATHLESS CHILD

Disorders of the respiratory tract are common in childhood. Most respiratory
illnesses are self-limiting minor infections, but a few present as potentially life-
threatening emergencies. Important causes of a breathless child are:

● Asthma

● Bronchiolitis

● Pneumonia

● Anaphylaxis.

Asthma

DIAGNOSIS

1 This is reversible airways obstruction associated with infection (usually

viral), allergy, atopy, exercise and/or emotion.

2 It is one of the most common reasons for admission to hospital in childhood.

3 Asthma presents with dyspnoea, wheeze and cough. Obtain a history regard-

ing trigger factors, treatment used, intercurrent illness and previous inten-

sive care unit (ICU) admissions.

4 Make a similar assessment as in adults. Include the heart rate, respiratory

rate, oxygen saturation and peak f low prior to treatment (see p. 65).

5 Look for tachycardia with a full pulse, tachypnoea with prolonged expira-

tory phase, nasal f laring, intercostal recession and expiratory wheeze on

examination.

6 Markers of severe asthma include any one of:

(i) Oxygen saturation <92%.

(ii) Too breathless to talk or feed.

(iii) Respiratory rate of ≥50 breaths/min if aged 2–5 years, or >30/min

if >5 years.