Special Feature
between children and adults that have an impact on pediatric assessment and management. The child is not only phys‐ ically smaller but also has respiratory and cardiovascular systems that are immature, with fewer reserves than those of the adult. Consequently, the child in respiratory or cardiac distress will likely decompensate more rapidly than the adult with a comparable illness or injury. A child's psychosocial and com‐ munication skills are constantly chang‐ ing; therefore, the child may be unable to convey key information to assist the EMS practitioner in their assessment. These differences, as well as numerous others, are why prehospital practition‐ ers must develop assessment skills that address the unique aspects and needs of the pediatric patient.
with the three triangle components assessed in any order.
PAT Components and Assessment Strategies
The “across the room” assessment is comprised of three important compo‐ nents: • General appearance • Work of breathing • Circulation to skin
General Appearance
The general appearance reflects the adequacy of ventilation, oxygenation, brain perfusion, body homeostasis, and central nervous system function. The child’s general appearance is the most important component to consider when determining how severe the injury or illness is, the need for treat‐ ment, and the response to therapy. Strategies: ‐ Assess the patient from across the room and allow the child to remain on caregiver’s lap.
‐ Use bright lights or toys to measure how interactive the child is with the environment.
‐ Have the caregiver assist with assessment if appropriate.
Pediatric Assessment Triangle
The Pediatric Assessment Triangle (PAT) is one tool that provides a sys‐ tematic and comprehensive approach to the initial assessment of the child. This model for emergency assessment of the child has been incorporated into most standardized pediatric life sup‐ port courses, including the AAP Pediatric Education for Prehospital Professionals, AHA Pediatric Advanced Life Support course, and the NAEMT Emergency Pediatric Care Course. The PAT is a rapid and simple obser‐ vational tool suitable for emergency pediatric assessment regardless of the presenting complaint or underlying diagnosis. The PAT allows the EMS prac‐ titioner to develop a general impression of the child from across the room and can be completed in 30 to 60 seconds
22 EMS PRO Magazine Work of Breathing
How hard the child is working to breathe is a more accurate, quick indi‐
cator of oxygenation and ventilation than respiratory rate or chest sounds on auscultation. It reflects the child’s attempt to make up for difficulties in oxygenation and ventilation. Important features to look for that would require immediate attention and intervention: ‐ Abnormal airway sounds: Snoring, muffled or hoarse speech, stridor, grunting, wheezing
‐ Abnormal positioning: Sniffing posi‐ tion, tripod position, refusing to lie down
‐ Retractions: Supraclavicular, inter‐ costals, or substernal retractions of the chest wall; head bobbing in infants
‐ Flaring: Nasal flaring Circulation to Skin
Skin circulation reflects the adequacy of cardiac output and core perfusion, or perfusion of vital organs. Cold room temperatures may cause false skin signs, (i.e., the cold child may have nor‐ mal core perfusion but abnormal circu‐ lation to the skin). Strategies: ‐ Look at the skin (i.e., face, chest, abdomen) and mucous membranes (lips, mouth) for color in central areas. In dark skinned children, the lips and mucous membranes are the best places to assess circula‐ tion.
Important features to look for that
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