ANZCOR Guideline 9.2.12 - Recognition and

First Aid Management of the Seriously Ill Person including Sepsis

Summary

Who does this guideline apply to?

This guideline applies to adults, children and infants.

Who is the audience for this guideline?

This guideline is for use by bystanders, first aiders and first aid training providers.

Recommendations

The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations:

First aiders learn to recognise a seriously ill person [Good Practice Statement]
If serious illness is suspected, send for an ambulance - delayed treatment can quickly lead to more serious illness and death. [Good Practice Statement]

Abbreviations

ANZCOR: Australian and New Zealand Committee on Resuscitation

Guideline

1 Introduction

There are many conditions that present in the community that need urgent assessment and treatment by health care professionals. The nature of most of them is obvious but some are difficult to diagnose even under ideal circumstances in hospital. One frequent example is sepsis. There are a number of other conditions that are hard to distinguish from sepsis. However, the diagnosis of the exact condition is not important for the first aider because these conditions share a common set of symptoms and signs. It is more important to recognise that a person needs urgent medical care than to diagnose the nature of the illness. There is very little published about the first aid management or recognition of these conditions. There is a growing body of evidence about how health care professionals should 'recognise the deteriorating patient.' The purpose of this guideline is to help the first aider recognise the person in need of urgent medical care but is not intended for the diagnosis of illnesses.

More information on sepsis can be found on the Australian Sepsis Network website (https://www.australiansepsisnetwork.net.au)

2 Causes

Anyone can deteriorate quickly with a serious illness, but certain people are at higher risk including¹ :

children under 10¹
people over 65 years of age^2,3,4
people with chronic diseases
people with weakened immune systems
Aboriginal and Torres Strait Islander Peoples, Maori and Pasifika

3 Recognition

Early recognition of serious illness is critical as early treatment improves outcomes. These symptoms and signs set out below may indicate serious illness. These symptoms and signs are common to many conditions and it is their combination that alerts health professionals^ to the possibility of serious illness and prompts further investigation and treatment. The more signs and symptoms in combination, the higher the risk that the underlying problem is a serious illness. Perhaps the most important indicator is that the person with a serious illness feels 'not right' or say they might feel they are 'going to die'.⁹ This is even more significant if the people that know this person have noticed a change in their behaviour.⁶

3.1 Red Flags for serious illness.

The more red flags present, the greater the concern that the person is seriously ill.

The bulk of the evidence related to serious illness in adults is from in-hospital studies, so the indicators of serious illness in adults are extrapolated from that evidence. The indicators of serious illness in adults include:^8-13

rapid breathing (breathing rate ≥22 / minute) is the most reliable indicator of serious illness in adults
breathlessness or feeling short of breath
restlessness, agitation, dizziness, decreased level of consciousness, confusion, slurred speech or disorientation
shivering or shaking, fever or feeling very cold
unexplained muscle pain or discomfort
passing little or no urine
rapid heart rate
nausea and or vomiting
new rash or blotchy, pale, or discoloured (often described as mottled) skin;
person may say they 'don't feel right' or they might say they feel like they 'are going to die'.

3.2 Serious illness in children and infants

Children and infants with serious illness can deteriorate quickly. Symptoms and signs of serious illness in infants and children may include:¹4

rapid breathing, weak cry or grunting
hard to wake, lethargic or floppy
seizure or fits
a rash that doesn't fade when pressed
discoloured, mottled, very pale or bluish skin
fever, feeling cold or cold to touch
vomiting repeatedly
not passing urine (or no wet nappy) for several hours
not feeding or drinking.

Children often cannot express how they feel so look for the combination of an infection with any of the signs and symptoms listed.

In children, parental concern that this illness is more severe or different and care providers thinking “something is wrong” are predictive of the presence of sepsis.⁵

4 Management

Serious illness is a medical emergency and typically requires in-hospital management and the prompt administration of medications or an operation which targets the infection or other illness.

Send for an ambulance if:

you suspect sepsis or other serious illness;
an infection related illness is not improving;
carer is concerned that this illness is more severe or different;
care providers (including first aiders) think “something is wrong”.

4.1 Those that are unresponsive, unconscious or fitting

Send for an ambulance.

if the person is unresponsive and not breathing normally, commence resuscitation following the Basic Life Support Flowchart [Refer to ANZCOR Guideline 8];
if the person is unconscious but breathing, lie them on their side, ensure the airway is clear [Refer to ANZCOR Guideline 3] and keep them under observation;
if the person is having a seizure, lie them on their side, ensure the airway is clear [Refer to ANZCOR Guideline 3 and Guideline 9.2.4] and keep them under observation;
administer oxygen only if there are obvious signs of shock or evidence of low oxygen saturation according to use of Oxygen in Emergencies [Refer to ANZCOR Guideline 9.2.10 ].

4.2 Those that are conscious