SSSS ABCD is usually apply to save an unwell child or patient

1. ABCD Approach to an Unwell Child
with Signs of Life
ETAT+ Sierra Leone 2020

2. Learning Objectives
At the end of the session you will be able to:
• Perform initial assessment of an unwell child with signs of
life
• Recognise warning signs and provide immediate care to
the sick child and prevent their complete collapse
• Make immediate decisions on management, even without
history

3. SSSS ABCD
Safety, Stimulate, Shout, Setting
Airway
Breathing
Circulation
Disability

4. The 4 S’s
Safety
 Check for sharps or dangerous equipment
 Hand hygiene/Personal Protective Equipment (PPE)
Stimulate
 If not alert, call/stimulate the patient/ask carer to call/stimulate
Shout
 Shout for more help or send a carer or bystander to get help
Setting
 Clinical area, patient position

5. Airway: Assessment
LOOK for vomit,
secretions or
foreign body in
the mouth
LISTEN for
stridor, noisy
breathing or
choking
Is the child alert
enough to
maintain their
own airway?

6. Airway: Treatment
• Open airway
• Remove foreign body – suction
• Position airway:
<1 year: neutral position
>1 year: sniffing position
• Jaw thrust
• Oropharyngeal (Guedel) or
Nasopharyngeal airway
• Oxygen

7. Breathing: Assessment
Look, listen, feel: present and adequate?
Respiratory rate
Central cyanosis
Increased work of breathing: head nodding, nasal flaring,
grunting, chest wall indrawing, deep acidotic breathing
Wheeze or crackles
Oxygen saturation

8. Breathing: Treatment - Oxygen
• When to start oxygen therapy:
• Obstructed breathing
• Central cyanosis
• Severe respiratory distress
• Signs of shock
• Unconscious child
• Oxygen saturation <90% in air

9. Breathing: Treatment - Supportive
Measures
• Salbutamol for wheeze in >1 year old
• Position – sitting up/forward
• Minimal handling – avoid distressing the child
• Maintenance IV fluids or NG feeds

10. Circulation: Assessment
Check:
Large/central
pulse
Peripheral
pulse
Temperature
gradient
Capillary
refill time

11. Circulation: Signs of Shock
Shock
Cold
extremities
CRT>3s
Weak and
fast pulse

12. Circulation: Further Assessment
• Palmar pallor compared to mother/carer
Severe
Anaemia
• Muscle wasting - buttocks, shoulders
• Pitting oedema of both feet
Severe
Malnutrition
• Diarrhoea + two or more of:
• Sunken eyes
• Lethargy
• Slow skin pinch >2s
• Inability to drink
Severe
Dehydration

13. Circulation: Treatment
Fluids or blood as per protocol based on presence
or absence of:
• Shock
• Severe anaemia
• Severe Acute Malnutrition (SAM)
• Severe dehydration

14. Disability: Assessment
AVPU
Blood
glucose
(sugar)
level
Convulsions

15. Disability: Treatment
If blood glucose <3mmol/L
or AVPU = V, P or U then give:
5ml/kg of 10% Dextrose IV
Anticonvulsant medications as per protocol

16. Safety Stimulate
Shout Setting
Airway
Support? Suction?
Foreign body?
Breathing
Oxygen?
Salbutamol?
Circulation
Fluids? Blood?
Disability
Dextrose?
Anticonvulsants?
Each stage must be
assessed and
stabilised before
you move onto next
one
SSSS ABCD Assess and Treat

17. Questions?

18. Summary
• SSSS
• Airway
• Position, suction, support
• Breathing
• Oxygen
• Circulation
• Fluids/blood
• Disability
• Dextrose
• Anticonvulsants

19. Thank you so much for
your attention!