References
The paediatric assessment triangle: a powerful tool for the prehospital provider
Abstract
The paediatric assessment triangle (PAT) is an internationally accepted tool in paediatric life support for the initial emergency assessment of infants and children. It is a rapid, global assessment using only visual and auditory clues, and takes only seconds to perform. The PAT has three components: appearance, work of breathing and circulation to skin. It is the first step in answering three critical questions: (1) How severe is the child's illness or injury? (2) What is the most likely physiologic abnormality? and (3) What is the urgency for treatment? The combination of abnormalities observed by the three components defines one of six categories of clinical status: stable, respiratory distress, respiratory failure, shock, central nervous system (CNS)/metabolic disorder, or cardiopulmonary failure. The category of illness and its severity drives management priorities and determines the initial treatment. In addition, the PAT provides a common vernacular for emergency clinicians and may be applied repeatedly to track clinical status. This article will furnish the prehospital provider with an approach to the recognition and treatment of the acutely ill or injured child.
Emergency assessment of a critically ill or injured infant or young child is often difficult, even for the experienced provider (Hohenhaus, 2006). History, when available, is usually gained through a third-party filter—the child's caregiver. The child may be too young, frightened, or disabled to respond to questions (Adirim and Smith, 2006). Vital signs—the cornerstones of adult assessment—may be difficult to interpret because of age-based variation, lack of sensitivity (blood pressure) or poor specificity (heart rate, respiratory rate) (McCarthy et al, 1985; Dieckmann et al. 2000; Dieckmann et al. 2010). In addition, any individual prehospital provider may have relatively infrequent encounters with critically ill or injured children, which limits opportunities to reinforce both cognitive and psychomotor skills (Gausche et al. 1990; Gausche et al, 1998a; Gausche et al, 1998b; Gausche, 2000).
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