Open Airway

• The first step in acute care for kids is assessing the airway. If an acute situation arises from a witnessed event, the child's airway can be opened by the head-tilt chin-lift method. Be careful not to overextend the child's neck. Children's tracheas, or windpipes, which run from the back of the mouth into the lungs, are more flexible than adults'. The child's airway can be closed off if the neck is hyperextended. You should place the head in the "sniff" position---this is a gentle chin-lift that mimics the movement the child's head would make if he had just sniffed something.
  
  

Clear Airway

• Once the airway has been opened, you should open the mouth by pulling down on the lower jaw with your thumb and index finger wrapped on top and bottom of the chin. You can then perform a visual airway check to see if anything visible is blocking the airway. Never do a blind finger sweep, which is sweeping the back of the throat with your finger to search for a blockage. This could result in pushing an unseen object farther down the airway.
  
  

Airway Considerations

• If an acute situation arises from an unwitnessed event or the child has suffered a head or neck injury, do not perform the head-tilt chin-lift method to open the airway. A jaw-thrust is required to open the airway and will not aggravate a potential spinal injury. A jaw-thrust can be performed by placing your fingers on the angular parts of the lower jaw just below the ears. Push the jaw forward. Oftentimes, the jaw thrust must be held in position until further interventions can secure the airway.
  
  

Breathing

• Breathing that is adequate to sustain life is different from any old breathing. Children's normal rates of respiration range from 15-to-50 breaths per minute, depending on the age of the child. During acute-care situations, respiratory rate may increase or decrease beyond the normal range. When assessing breathing, you should look for an equal rise and fall of the chest, listen for abnormal breath sounds like snoring or wheezing and look for use of accessory muscles. Inadequate breathing may cause nasal flaring or retractions, especially in young children. Retractions occur when the abdominal muscles are used during exhalation.
  
  Inadequate breathing can be assisted with artificial respiration, using a pocket mask or bag-valve mask. Administer oxygen.
  
  

Circulation

• Assessing the circulation of an acute pediatric patient means checking for a pulse. You should first check for a radial pulse -- the pulse found on the inside of the wrist. If no radial pulse can be detected, you should check for a carotid pulse. The carotid pulse can be found on either side of the trachea which is in the center of the child's neck. Do not check both carotid pulses simultaneously as this could compromise blood flow to the brain. Next, check the color, temperature and moisture level of the skin. The best way to do this is by placing the back of your hand on the kid's forehead. Skin tone can be assessed by looking at the patient's lips, nail beds or the inner lining of the mouth. Skin should be warm, dry and pink -- indicating blood flow. If it is blue or grey then you know that blood and oxygen are not reaching the tissues. This is called hypoperfusion, or shock.
  
  

Shock

• Preventing shock is very important in acute care for kids. Children have much less blood in circulation than an adult. Children are therefore at risk for shock with any significant blood loss. Unfortunately, once shock symptoms are present in a child, his stability can deteriorate very rapidly. Treat for shock before symptoms are presented. When bleeding is uncontrolled, internal injuries are suspected and the patient does not have a head or spine injury, elevate the legs to allow blood to remain in the core of the body. Cover the child with a blanket to keep him warm. Administer oxygen.