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Acutely unwell child

The purpose of this guideline is to provide guidance about treatment of the acutely unwell child at Great Ormond Street Hospital.

Flowchart of procedure for treating an acutely unwell child

Does the child need immediate help?

  • Yes
    • Activate Clinical Emergency Team (2222).
    • Resuscitate, stabilise.
    • CSP/ICON Fellow discusses plan with speciality consultant +/- ICON consultant.
    • If complex or PICU admission anticipated:
      • ICON/PICO consultant contacts specialty consultant to discuss admission. If the child’s lead consultant cannot be contacted, the PICU consultant will organise admission and continue resuscitation. Efforts will continue to contact the lead consultant.
      • Decision to admit to PICU:
        • Yes – transfer to PICU.
        • No - child remains on ward and managed by specialty consultant, and CSP +/- ICON Fellow.


  • No
    • Bleep CSP and specialty SpR for joint review.
    • Discuss management with child’s consultant and ? referral to ICON. If the child’s lead consultant cannot be contacted, the PICU consultant will organise admission and continue resuscitation. Efforts will continue to contact the lead consultant.
    • If the child’s condition deteriorates, ICON Fellow offers medical consult and management plan.
    • CSP/ICON Fellow discusses plan with speciality consultant +/- ICON consultant.
    • If complex or PICU admission anticipated:
      • ICON/PICO consultant contacts specialty consultant to discuss admission. If the child’s lead consultant cannot be contacted, the PICU consultant will organise admission and continue resuscitation. Efforts will continue to contact the lead consultant.
      • Decision to admit to PICU:
        • Yes – transfer to PICU.
        • No - Child remains on ward and managed by specialty consultant, and CSP +/- ICON Fellow.
      • Otherwise, child remains on ward and managed by specialty consultant, and CSP +/-ICON Fellow.

Further reading

Reference 1:
Tibballs J, Kinney S, Duke T, Oakley E, Hennessy M (2005) Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results. Arch Dis Child  90 (11): 1148-52.

Reference 2:
Young KD, Seidel JS (1999) Pediatric cardiopulmonary resuscitation: a collective review. Ann Emerg Med 33 (2): 195-205.

Reference 3:
Tume L (2007) The deterioration of children in ward areas in a specialist children's hospital. Nurs Crit Care 12 (1): 12-9.

Document control information

Lead author(s)
Sue Chapman, Nurse Consultant, Clinical Site Practitioners

Additional authors
Judith Ellis, Former Chief Nurse and Director of Workforce Development, Executive 

Document owner
Sue Chapman, Nurse Consultant, Clinical Site Practitioners

Approved by
Model of Service, Emergency Work Stream and Clinical Practice Committee

First introduced: 15 December 2004
Date approved: 12 January 2012
Review schedule: Two years 
Next review: 12 January 2014
Document version: 3.0
Replaces version: 2.0

 

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