Certain emergencies of the airw ay, breathing, circulation and neurological
systems are dealt with in the chapters
on respiratory, cardiac and nervous
system, respectively. This section deals only with the approach to the severely
ill child and selected conditions (cardiorespiratory arrest), anaphylaxis, shock,
foreign body inhalation and burns. All doctors should ensure that they have
received appropriate training to prov ide at
least the basic (and preferably
advanced) life support to children.
The most experienced clinician present should take control of the resuscitation.
RAPID TRIAGE OF THE CHILD PRESENTING WITH
ACUTE CONDITIONS IN CASUALTY/OUT PATIENTS
Many deaths in hospital/healt h centres oc cur at or early after presentation.
Some of th ese deaths can be prevented if v ery sick children are qui ckly
identified upon arrival and treatment is started without delay.
The word “triage” means sorti ng. The idea of triage is to identify very sick
children who will benefit from immediate emergency care f rom those w ho
should receive priority care (be placed ahead of the normal queue) or those
who can wait to be seen in the normal order of arrival. Triage is the process of
rapidly examining all sick children when they first arrive in hospital in order to
place them in one of these categories and should be reassessed regularly
while awaiting care.
1 Emergencies: Conditions which cannot wait and require immediate
2 Priority signs (place ahead of normal queue).
3 Non-urgent (queue).
EMERGENCIES AND TRAUMA
Emergencies: conditions which cannot wait and require
If any emergency sign positive: give emer
gency treatment(s), call for help, and
draw blood for emergency laboratory investigations.
(A&B) Airway and breathing
» Not breathing.
» Obstructed breathing.
» Central cyanosis.
» Severe respiratory distress.
» Capillary refillt 3 seconds.
»Weak and fast pulse.
» Convulsing (now).
(D) Severe dehydration (only in child with diarrhoea)
Diarrhoea plus any two of these:
» Sunken eyes.
» Very slow skin pinch.
These children need prompt assessment and treatment:
» tiny baby (< 3 months),
» temperature very high or very low,
» trauma or other urgent surgical condition,
» pallor (severe),
» poisoning (history of),
» pain (severe),
» respiratory distress,
» restless, continuously irritable, or lethargic,
» referral urgent (from another health professional),
» malnutrition: visible severe wasting,
» oedema of both feet,
» burns (major).
Proceed with assessment and further treatment according to the child’s
A number of different triage processes exist and the above is taken from the
South African Emergency Triage Assessment and Treatment (ETAT) course.
Other systems may include, in addition, the use of clinical markers such as
respiratory rate, blood pressure and pulse rate to add precision to the triage,
especially in more resourced settings.
Other important conditions are sometimes added to the ETAT guidelines to
suit particular local conditions such as identifying infectious diseases that
need immediate isolation, dehydration (not severe), facial or inhal ational
burns, evidence of meningococcal septicaemia, inconsolable crying, etc.
The ETAT triage presented above should be a minimum standard of triage in
community health centres, district or regional hospitals in South Africa.
Additional items may be added suitable to local conditions and resources.
APPROACH TO THE RESUSCITATION OF THE CHILD
In approaching a child with potential severe illness or inj ury a struct ured
approach will improve the child’s chances of a best possible outcome in the
shortest possible time. The following is a diagrammatic overview derived
from an advanced Paediatric life support approach.
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