Pediatric Assessment Triangle (PAT)

This micro-lecture discusses the Pediatric Assessment Triangle because assessing a child is very, very complex.

In today’s micro lecture, we are going to talk about the pediatric assessment triangle. Now assessing a child is very, very complex, because not only are children not small adults, meaning that their signs and symptoms of illness and the vital signs going to be different, but also psychologically, they are different to us as well. Now the good news is there are a number of different assessment frameworks you can use to help make life a little bit easier for you.

Now just remember, that when you arrive on scene at a child, and we’re using the word child to mean anybody up to the age of puberty, because you know as well as I do it’s not always that straightforward. You have newborns, you have infants, toddlers, pediatrics, and a whole range of other different names to classify within the different ages. But this pediatric assessment triangle really does allow you to assess not only any child, but also any adult.

Now this pediatric assessment chart triangle is a standoff assessment. In other words, you’ve arrived on scene. Hello, ambulance. Where am I, who am I going to? You can look at the patient and you can use the pediatric assessment triangle, now called the patient assessment triangle, to determine how ill and unwell the person actually is.

You’re using three criteria. Number one, the general appearance. In other words, are they looking at you? Do they have any abnormal tone, remembering tone is about muscle contractions. It’s a muscular thing. So if they’re floppy, then they don’t have very good muscle tone.

What about their interactiveness? When they look at you, are they actually looking at you or are they scared of you? Now it’s generally quite normal for children to be scared, depending on the age, some children.

That’s the other thing, I mean, no two children are the same. Some people love other people, others don’t. But of course, you’ve got to try and work out what’s normal in comparison to abnormal with the parents.

Now there are clearly going to be things around appearance, work of breathing, of circulation, that are clearly not normal, and that’s fine. But where there’s that fine line between this is how they behave and this is how they’re behaving now, get the parents involved.

Abnormal look or gaze. In other words, are they looking at you, are they not? Are they looking semi-conscious? Do they have any abnormal speech or cry? And of course, can you console them as well? Consolability really, really important. And when I say you, I don’t mean you as the complete stranger that’s just walked in to this person’s world, but the parents.

Work of breathing. You’re looking for all these different things, abnormal sounds or added sounds, abnormal positioning of the patient, retractions in between … Use of accessory muscles. Is there nasal flaring, which means that there is problems with the ventilation system and hypoxia, or are there any signs of apnea, periods of not breathing and gasping for air?

Circulation to the skin. Do they look pale? Do they look blue? Do they look mottled? In other words, is there any redness? Is there any signs of any illness? You can do all of this just by looking at your patient as you approach.

I hope you enjoyed this micro lecture. Thank you for your time. Please go and look into the literature around the patient assessment triangle, and I look forward to speaking to you again shortly.

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