Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Child with immediate airway, breathing or circulation compromise
A child who is apnoeic, gasping, cyanosed, profoundly exhausted, poorly perfused, bradycardic, unresponsive or fitting is peri-arrest until proved otherwise.
Action: Call the paediatric emergency or resuscitation team immediately, start an ABCDE approach and treat threats as they are found. Open and protect the airway, give oxygen for hypoxaemia or critical illness, support inadequate breathing with bag-mask ventilation, attach monitoring, obtain intravenous or intraosseous access without repeated delay, check bedside glucose and prepare age- and weight-appropriate resuscitation equipment and medicines. Use the Resuscitation Council UK paediatric algorithm, reassess after every intervention and arrange critical-care transfer early.
Synopsis
Detect paediatric deterioration before collapse by combining first-impression physiology, repeated ABCDE assessment, age-specific observations, National PEWS trends, family concern and decisive senior escalation.
Use the paediatric assessment triangle on first sight: appearance, work of breathing and circulation to skin; any abnormal arm means the child needs prompt hands-on assessment.
Move immediately to ABCDE, treat each life threat before proceeding and repeat the whole sequence after intervention or change.
Interpret heart rate, respiratory rate and blood pressure against age, temperature, pain, medication and trend; a single adult threshold is unsafe.
Key red flags
Apnoea, gasping, central cyanosis, silent chest, severe stridor, exhaustion or decreasing respiratory effort indicates impending respiratory arrest.
Investigation priorities
01
First-line: repeated full observations with National PEWSFirst stepFirst line
Quantify age-specific physiology, oxygen requirement and consciousness and activate standard escalation.
02
First-line: continuous cardiorespiratory monitoringFirst line
Detect rapid change in a child with airway, breathing or circulation compromise.
Management branches
First sightPAT then immediate ABCDE
Any child appears unwell, behaves abnormally or is flagged by family or staff.
Assess appearance, work of breathing and circulation to skin within seconds and call early help if any arm is abnormal.
Perform ABCDE with age-appropriate observations, treating each threat before moving on.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.