Identification of a life-threatening child 1

Recognizing a life-threatening child, since the survival rate of cardiac arrest in children is often low, it is extremely important to recognize the signs of life-threatening situations in time. Recognizing the symptoms and signs of a serious condition is more important than establishing a diagnosis. The causes of cardiac arrest differ between children and adults.

In adults, cardiac arrest usually occurs suddenly, because the heart suddenly stops beating in the presence of arrhythmias. However, cardiac arrest in children is most often the result of hypoxia.

Generally, disease or injury causes primary respiratory or circulatory failure, leading to hypoxia and acidosis, and ultimately cardiac arrest.

ABCDE assessment

ABCDE assessment enables rapid identification and management of children. Issues that arise during the assessment should be addressed as they arise. An ABCDE assessment should take no longer than two minutes, unless specific procedures are required to resolve the problem.

A (breathing) – breathing

B (breathing) – breathing

C (circulation) – circulation

D (neurological status) – neurological status

E (exposure) – exposure

Vital signs and parameters should be known, and the equipment adapted to the child’s age. A variety of assessment tools can be used, such as the Broselow tape, pediatric pocket guides, apps, and others.

All management procedures begin with an assessment of the incident site and staff and patient safety.

Attention should be paid to the specifics in children, including:

  • High epiglottis (susceptible to obstruction).
  • Children younger than 6 months breathe through the nose (secretions can cause respiratory failure).
  • A large head and head-to-neck ratio can cause partial obstruction.
  • Small face and mouth structure with a large tongue.
  • The cricoid cartilage is located high, which makes it more sensitive to swelling.

When assessing the airway, ask several key questions:

  1. Is the airway blocked?
  2. Is the airway at risk?
  3. Is the airway open?

The airway should be examined for possible obstructions by a foreign body or vomit. The younger the child, the less it is necessary to tilt the head. For an infant (child up to 12 months), a neutral position (placing a support under the shoulder) is used to achieve a “carrying position”. While assessing the airway, listen for sounds such as stridor or snoring.

In case of suspected trauma, the airway is opened by pushing the lower jaw forward and upward.


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