ABSTRACT
This chapter outlines some of the general principles that underpin the care of the very sick child, and highlights some of the features of child abuse that may present in an ORL clinic. Much emphasis is given to the care within the first hour, the so-called 'golden hour', which governs the trajectory of subsequent management. Regardless of whether the lungs are normal or diseased, a 'lung-protective' ventilator strategy should be used. An awareness of the normal parameters is essential, as deviations away from these allow the clinician to recognize them at the earliest opportunity. There may also be signs of abnormal central neurological function in the respiratory and circulatory systems, with altered breathing patterns, hyperventilation or apnoea. With this simple but highly effective order of assessment, using airway, breathing, circulation, disability and exposure, the correct priorities are set to ensure that important features in the recognition of the sick child are not missed.
