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Spotting The Sick Child (STSC)

This section is a work-in-progress, writing notes from the Spotting the Sick Child (STSC) online course *

The 3 minute toolkit​

ABCDENTTT

A – Airway – Is it obstructed?

  • eg secretions, foreign body, stridor
  • unprotected airway - tolerance of OP airway?

B – Breathing – Is the child struggling to breathe?

  • Assess respiratory rate, look for recession/accessory muscle use, check oxygen saturation, auscultate the chest
  • Auscultation - wheeze (asthma), crepitations (bronchiolitis), bronchial breathing
  • SpO2 < 94% imply significant illness

C – Circulation – Is there evidence of poor circulation?

  • Assess colour skin, heart rate, capillary refill time (on sternum and fingers/toes), blood pressure, warm or cold hands/feet?
  • Pallor, mottling (hypoperfusion)
  • Cold peripheries and delayed CRT (> 2 seconds) imply peripheral vasoconstriction(ie sepsis, dehydration)
  • Peripheral CRT is more sensitive to early hypoperfusion than central CRT, but is also affected by cold environment
  • Children maintain a normal BP until very unwell due to effective peripheral vasoconstriction

D – Disability – What is the child’s neurological state?

  • Assess pupil response to light, limb tone and movement, AVPU score/GCS, irritable (unconsolable)
  • Pupils
    • Sluggish pupils - drug overdose or post-ictal
    • Changing sizes - ongoing seizures
    • Asymmetry - space occupying lesion
    • Abnormal gaze following seizure

E – Exposure – Have you exposed the child and examined top-to-toe?

  • Rashes – viral rash, infectious disease rash, non-blanching rash (septicaemia?)
  • Any evidence of injury/trauma
  • Bruises – Always think Non-accidental injury in the non-mobile child
  • Use any safeguarding skills you have learnt on accredited courses in child protection to identify any marks on the skin, or how a child is kept, or their interaction with the parent(s)/guardian(s).

ENT – Ears, Nose and Throat
Mandatory in any febrile child Pink ear drums, and large red tonsils are seen in most febrile children and are non-specific for otitis media or tonsillitis

T – Temperature

  • Use a tympanic or axillary (infant) thermometer.
  • You may require a rectal thermometer in the very unwell child

T – Tummy – Is this soft? Distended? Tender? What are the bowel sounds like? Any masses? Any hernias? Tenderness, peritonism, masses? Distractible pain?

  • In boys, never forget to examine the testis (testicular torsion = surgical emergency)
  • Urinalysis

D E F G – Don’t Ever Forget Glucose! 3 - 5 mmol/l

Normal Values​

Paediatric-Observations-Normal-Range