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ABCDE management of an unwell child [advanced]

A to E assessment

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Note: Only move to the next letter when the one before has been treated, and keep re-assessing ABCDE from the start as necessary

Normal observations

NORMAL<1 year1-2 years2-5 years5-12 years>12 years
Resp rate30-4025-3525-3020-2515-20
Heart rate110-160100-15095-14080-12060-100

Amber and red flags

 Amber flagsRed flags
A Stridor
BNasal flaring, tachypnoea, sats <95%Respiratory distress (RR>60)
CPallor, tachycardia, reduced capillary refill, reduced UO, dry mucus membranesPale/mottled/blue, reduced skin turgor
DReduced activity, not responding normally to social cuesUnresponsive/won’t stay awake, non-blanching rash/neck stiffness, seizures
ERigors, fever in 3-6month oldFever in <3month old

Possible investigations

  • Review child’s history in medical notes to help determine what is required
  • Only do investigations that will change management
  • BOXES
    • Bloods: FBC, CRP, cultures, VBG, capillary blood gas (if low sats), glucose
    • Orifice tests: urine dip and culture (parents to wait with sterile pot; in and out catheter may be used in young children if waiting too long); stool culture (if diarrhoea)
    • X-rays/imaging: CXR (if respiratory signs)
    • ECG (if HR>200 – ?SVT)
    • Special tests: lumbar puncture (if <3months or very unwell or meningitis suspected)
  • Any condition specific treatments

Request help as required

  • Inform senior

Document in notes

  • Document with a brief case summary, ABCDE headings with findings and management
  • Review child and results as necessary
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