ABCDE assessment and stabilisation of the acutely ill child — formative SAQs

1. First 60 seconds

"This infant is critically unwell with abnormal appearance, work of breathing and circulation to skin. I call the senior paediatric and resuscitation teams now, name a leader, allocate roles, and bring age- and weight-appropriate equipment and monitoring. I begin the hands-on primary survey immediately." The principle is recognise and call for help, then treat life threats as they are found; stabilisation precedes diagnosis. [9]

2. Age-adapted ABCDE stabilisation

A — Airway. Assess patency, position, abnormal sound or silence, secretions, and whether the infant can maintain and protect the airway. Position the airway, clear removable obstruction by suction, avoid agitating a threatened airway, and call airway expertise before failure. [9]

B — Breathing. Give high-flow oxygen initially because the infant is in failure; per the AHA 2020 guideline the previously healthy target is a saturation of 94 to 98%, using the lowest fraction that achieves at least 94%. Judge effective ventilation by chest rise, air entry, improving colour and interaction, not the monitor alone; I confirm a credible oximeter signal because oximetry does not measure ventilation. If breathing is ineffective I support it with a correctly sized bag and mask. [9]

C — Circulation. Diagnose shock from the whole picture (pulse rate and quality, skin colour and temperature, capillary refill with technique stated, blood pressure, mental state, urine output). Control obvious loss, gain access without repeated failed attempts, and give fluid in aliquots, stating the expected response before each and reassessing after each; the first-hour total is a ceiling, not a target. I stop for overload or no benefit, and I call for critical-care help early if vasoactive support may be needed. [3] [9]

D — Disability. Screen with AVPU; any response below Alert prompts a formal age-adapted Glasgow Coma Scale. Check bedside glucose now because feeding is reduced and the infant is unwell; I correct a dangerous low immediately through the local pathway and confirm when feasible without delaying treatment. [7] [9]

E — Exposure. Expose only what is needed, look for rash, injury and device problems, then cover and warm the infant; safeguarding documentation proceeds in parallel. [9]

3. The quieter infant

"A quieter chest after marked effort, with reduced air entry and reduced interaction, means respiratory muscle fatigue and impending failure, not improvement." I reassess effectiveness rather than rate alone. I support ventilation immediately, declare the improvement I expect, call airway or critical-care help, and reassess from A. Recovery requires easier breathing together with better air entry and improved interaction. [1] [9]

4. Reassessment, escalation and handover

After every action I return to A and check whether the expected change occurred; I record benefit, harm and unresolved threat, and I revise the differential from the trend. I escalate to senior, PICU or retrieval help as soon as the child may need support this service cannot provide, not after local options fail. The structured handover transfers identity and baseline, current physiology and trend, timed actions and response, the prioritised differential and pending tests, local limits, family and safeguarding information, and the next contingency and its owner. [8] [9]