In this chapter you will:
• Gain an understanding of normal assessment findings in the paediatric patient and those indicating deterioration
• Learn how to recognise a sick or deteriorating child using an appropriate framework
• Develop an understanding of how to respond to a sick or deteriorating child and provide appropriate respiratory and circulatory support
• Learn the elements of paediatric cardiopulmonary resuscitation • Consider the importance of supporting families and parental presence during paediatric resuscitation
As a nurse caring for paediatric patients, it is important for you to develop the ability to recognise and respond to a sick infant or child. The ability to do this is so important that a variety of projects have been undertaken, both internationally and throughout Australia, to ensure that nurses working with paediatric patients are able to recognise, respond promptly to and appropriately manage sick and deteriorating infants and children. Examples are the Between the Flags program in New South Wales, the Victorian Children's Tool for Observation and Response (VICTOR) and the Children's Early Warning Assessment Tool (CEWT) in Queensland. These programs aim to support the assessment skills of the clinician working with infants and children. Paediatric early warning tools help clinicians to recognise a deteriorating infant or child, and trigger an escalation in care to prevent further deterioration and achieve favourable outcomes. This chapter will provide you with a basic understanding and knowledge so that you will be able to recognise and respond to a sick and deteriorating child.
Clinical signs – a warning of deterioration – are often present in the paediatric patient as for as long as six to 12 hours before a catastrophic event. Failure to identify and treat these early warning signs can result in continued clinical deterioration until cardiopulmonary arrest. The poor outcomes associated with paediatric cardiopulmonary arrest emphasise the importance of being able to detect and respond to early signs of deterioration (McLellan & Connor, 2013).
The primary cause of paediatric cardiopulmonary arrest is respiratory in origin, and the second most common cause is circulatory failure.