Dr Sumeena Qidwai, who was due to see Caitlin that day, was with another patient when the receptionist told her she was needed urgently.

"I left the child I was examining and I ran," Dr Qidwai told the inquest.

She said she alerted another GP, yelling "emergency" as she ran past, and arrived to find Caitlin floppy and blue, with a pale face and body. She was unable to detect a pulse or hear a heart rate and observed Caitlin to be taking "very slow breaths".

"I just remember turning to Alex [the receptionist] and screaming 'call an ambulance', patient wasn’t responding, lights and sirens. I actually told him to tell them it was a category one."

Dr Qidwai said she was "extremely concerned" that Caitlin could deteriorate, describing the young girl as "probably the sickest child I’ve ever seen in an emergency in general practice".

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She said when paramedics arrived Caitlin had regained consciousness and "somewhat" improved, so she relayed the history of her lips turning blue and being unable to hear a heart rate.

"I expressed ... that I thought she may have been in imminent cardiopulmonary arrest," Dr Qidwai said. "There was some urgency and sense of immediately needing to get this child to the hospital."

When Caitlin was triaged at Westmead Children's Hospital at 2.37pm, she was recorded as having a history of a fever, with an ambulance called over concerns she was "flat" and not engaged. Ms Gerace said these notes "conveyed none of the urgency" of what had happened at the GP and did not record Caitlin's recent blue lips.

Ms Gerace said in Caitlin's time at the hospital, there was a delay in performing an electrocardiogram (ECG) because the machine had run out of battery. Caitlin was then transferred to a ward overnight without being assessed by a senior clinician.

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She deteriorated rapidly in the morning and was admitted to intensive care. She died at 11.15am on October 23 after a 45-minute resuscitation attempt, during which she was given adrenaline 13 times.

An autopsy found 50mL of fluid around Caitlin's heart, with her cause of death determined to be complications from an influenza B viral infection. Ms Gerace said the amount of fluid was described as "significant" and may ultimately be the cause for Caitlin's rapid deterioration and death.

A cardiologist is expected to tell the inquest that the three-hour ECG delay was "not acceptable", Ms Gerace said, and it is possible if a paediatric cardiology assessment was undertaken "this may have altered the course of Caitlin’s hospital admission … this may have prevented her death."

After Caitlin's death the hospital initiated a review of the care it provided, referring itself to the Health Care Complaints Commission. The HCCC found "a number of systemic shortcomings" and found Caitlin's care "inadequate in a number of respects".

The inquest continues.