Initial assessment and stabilization of children with respiratory or circulatory compromise
- Susan Fuchs, MD
Susan Fuchs, MD
- Professor of Pediatrics
- Northwestern University, Feinberg School of Medicine
- Section Editor
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Pediatric Emergency Medicine
- Texas Children’s Hospital
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The initial evaluation of critically ill children must quickly identify those with respiratory or circulatory compromise. Early recognition and treatment of a patient with deficiencies in oxygenation, ventilation, or perfusion frequently prevents deterioration to respiratory or cardiac arrest. Outcomes for children who develop cardiopulmonary arrest are poor [1,2].
This topic will review the clinical features that rapidly identify children with respiratory failure or circulatory compromise. Priorities for initial stabilization are presented.
Airway management techniques, including rapid sequence intubation (RSI), are discussed separately. (See "Basic airway management in children" and "Emergency endotracheal intubation in children" and "Rapid sequence intubation (RSI) outside the operating room in children: Approach".)
More detailed discussions of assessment of circulation and the definition and treatment of shock are also discussed in detail elsewhere. (See "Assessment of perfusion in pediatric resuscitation" and "Pathophysiology and classification of shock in children".)
Most children with respiratory or cardiovascular compromise can be easily recognized during a rapid initial assessment. Obvious examples include children with respiratory conditions such as severe asthma exacerbations, or inadequate perfusion, such as hypovolemic shock. (See "Assessment of perfusion in pediatric resuscitation".)
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- INITIAL ASSESSMENT
- Pediatric assessment triangle
- - Appearance
- - Work of breathing
- - Circulation to the skin
- Physical examination
- - Estimation of weight
- - Key assessments
- Ancillary studies
- - Pulse oximetry
- - End-tidal carbon dioxide measurement
- - Transcutaneous CO2 measurement
- - Arterial blood gas/venous blood gas
- INITIAL STABILIZATION
- Supplemental oxygen
- Assisted ventilation
- Circulatory support
- SUMMARY AND RECOMMENDATIONS