UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Initial assessment and stabilization of children with respiratory or circulatory compromise

Author
Susan Fuchs, MD
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

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".)

INITIAL ASSESSMENT

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".)

                  
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Jul 14, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Donoghue AJ, Nadkarni V, Berg RA, et al. Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Ann Emerg Med 2005; 46:512.
  2. Ludwig S, Kettrick RG, Parker M. Pediatric cardiopulmonary resuscitation. A review of 130 cases. Clin Pediatr (Phila) 1984; 23:71.
  3. Horeczko T, Enriquez B, McGrath NE, et al. The Pediatric Assessment Triangle: accuracy of its application by nurses in the triage of children. J Emerg Nurs 2013; 39:182.
  4. Gausche-Hill M, Eckstein M, Horeczko T, et al. Paramedics accurately apply the pediatric assessment triangle to drive management. Prehosp Emerg Care 2014; 18:520.
  5. Dieckmann RA, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care 2010; 26:312.
  6. American Academy of Pediatrics, American College of Emergency Physicians. APLS: The Pediatric Emergency Medicine Resource, 5th ed, Fuchs S, Yamamoto L (Eds), Jones and Bartlett Learning, Burlington 2012.
  7. American Academy of Pediatrics. Pediatric assessment. In: Prehospital Education for Prehospital Professionals, 3rd ed, Fuchs S, Klein BL (Eds), Jones and Bartlett Learning, Burlington 2016. p.1.
  8. Gausche-Hill M, Henderson DP, Goodrich SM, et al. Assessment. In: Pediatric Airway Management for the Prehospital Professional, Gausche-Hill M, Henderson DP, Goodrich SM, et al (Eds), Jones and Bartlett, Sudbury 2004. p.13.
  9. Young KD, Korotzer NC. Weight Estimation Methods in Children: A Systematic Review. Ann Emerg Med 2016; 68:441.
  10. Wells M, Goldstein LN, Bentley A. It is time to abandon age-based emergency weight estimation in children! A failed validation of 20 different age-based formulas. Resuscitation 2017; 116:73.
  11. DuBois D, Baldwin S, King WD. Accuracy of weight estimation methods for children. Pediatr Emerg Care 2007; 23:227.
  12. So TY, Farrington E, Absher RK. Evaluation of the accuracy of different methods used to estimate weights in the pediatric population. Pediatrics 2009; 123:e1045.
  13. Sinha M, Lezine MW, Frechette A, Foster KN. Weighing the pediatric patient during trauma resuscitation and its concordance with estimated weight using Broselow Luten Emergency Tape. Pediatr Emerg Care 2012; 28:544.
  14. Heyming T, Bosson N, Kurobe A, et al. Accuracy of paramedic Broselow tape use in the prehospital setting. Prehosp Emerg Care 2012; 16:374.
  15. Fuchs S, Terry M, Adelgais K, et al. Definitions and Assessment Approaches for Emergency Medical Services for Children. Pediatrics 2016; 138.
  16. Wells M, Coovadia A, Kramer E, Goldstein L. The PAWPER tape: A new concept tape-based device that increases the accuracy of weight estimation in children through the inclusion of a modifier based on body habitus. Resuscitation 2013; 84:227.
  17. Mace, SE. End-tidal CO2 monitoring: Noninvasive respiratory monitoring for the child in the ED. Pediatric Emergency Medicine Reports 2006; 11:13.
  18. Berkenbosch JW, Lam J, Burd RS, Tobias JD. Noninvasive monitoring of carbon dioxide during mechanical ventilation in older children: end-tidal versus transcutaneous techniques. Anesth Analg 2001; 92:1427.
  19. Abramo TJ, Wiebe RA, Scott SM, et al. Noninvasive capnometry in a pediatric population with respiratory emergencies. Pediatr Emerg Care 1996; 12:252.
  20. Tobias JD, Meyer DJ. Noninvasive monitoring of carbon dioxide during respiratory failure in toddlers and infants: end-tidal versus transcutaneous carbon dioxide. Anesth Analg 1997; 85:55.
  21. Burton JH, Harrah JD, Germann CA, Dillon DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med 2006; 13:500.
  22. DeNicola LK, Kissoon N, Abram HS Jr, et al. Noninvasive monitoring in the pediatric intensive care unit. Pediatr Clin North Am 2001; 48:573.
  23. Gennis PR, Skovron ML, Aronson ST, Gallagher EJ. The usefulness of peripheral venous blood in estimating acid-base status in acutely ill patients. Ann Emerg Med 1985; 14:845.
  24. Kirubakaran C, Gnananayagam JE, Sundaravalli EK. Comparison of blood gas values in arterial and venous blood. Indian J Pediatr 2003; 70:781.