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Pediatric Shortness of breathing
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Number of words “1085”
The Pediatric Assessment Triangle and its component
Figure 1 Pediatric Assessment Triangle
Is this child sick? Should I begin any emergency intervention? Any provider
should be able to answer quickly these questions whenever the provider
comes in front of a child seeking for urgent medical attention (in the
prehospital setting or emergency department [ED]).
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Scene safetyis an assessment of safety threats to the prehospital care
provider, patient, caregiver, and/or bystanders that may differ significantly
depending on the environment of practice. Aspects of scene safety may
include prevention of exposure to infectious disease and protection from
violence or other environmental hazards.
Objective. To provide an evaluation of the Pediatric Assessment Triangle
(PAT) as an assessment tool for use by paramedic providers in the
prehospital care of pediatric patients Methods.
The PAT is an observational tool used to make a “general impression,” which
uses a visual and auditory approach composed of noting the child’s general
appearance, work of breathing, and circulation, The PAT can be used
immediately on entering the scene and helps identify the general type of
physiologic problem ( respiratory, circulatory, or neurologic) and urgency for
treatment and transport.
Appearance is the most important component when determining how severe
the illness or injury is, the need for treatment, and the response to therapy. It
reflects the adequacy of ventilation, oxygenation, brain perfusion, body
homeostasis, and central nervous system function. This arm of the PAT is
delineated by the “TICLS” mnemonic: Tone, Interactiveness, Consolability,
Look or Gaze, and Speech or Cry. Important clues such as the infant's tone,
consolability, interaction with caregivers and others, and strength of cry can
inform the provider of the child's appearance as normal or abnormal (for age
and development).
Work of breathing describes the child's respiratory status, especially the
degree to which the child must work in order to oxygenate and ventilate.
Assessing work of breathing requires listening carefully for audible abnormal
airway sounds (e.g., stridor, grunting, and wheezing), and looking for signs of
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increased breathing effort (abnormal positioning, retractions, or flaring of the
nostrils on inspiration). The type of abnormal airway noise provides
information about the location of the disease, while the number and location of
retractions and the position of the patient report the intensity of respiratory
Circulation to the skin reflects the general perfusion of blood throughout the
body. The provider notes the color and color pattern of the skin and mucous
membranes. In the context of blood loss/fluid loss or changes in venous tone,
compensatory mechanisms shunt blood to vital organs such as the heart and
brain, and away from the skin and the periphery of the body. By noting
changes in skin color and skin perfusion (such as pallor, cyanosis, or
mottling), the provider may recognize early signs of shock.
It helps providers when determining how severe the illness or injury. Which is
general impression of Pediatric can help EMS to quickly determine
how critical the situation is without rushing right up to the child.
The acronym "TICLS" (pronounced "tickles") is sometimes used by
emergency medical providers to recall the components of the "Appearance"
Tone (muscle tone)
Abnormal: Limp, rigid, or absent muscle tone
Normal: Good muscle tone with good movement of the extremities. Infants
should strongly resist attempts to straighten their limbs
Abnormal: Crying is absent, or abnormal. The child cannot be stimulated to
cry. In addition to indicating an altered mental status, this may also be a sign
of an occluded airway .
Normal: Strong, normal cry (this is a reliable sign of a clear airway)
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Abnormal: The child cannot be consoled or comforted by usual caregivers,
The child does not respond normally to environmental stimuli, like preferred
toys .
Normal: The child is able to be consoled by usual caregivers. The child
responds in his or her usual way to environmental stimuli .
Look (gaze)
Abnormal: Vacant stare with lack of eye contact. The child may not seem to
recognize normal caregivers.
Normal: Child is able to make eye contact
Abnormal: The child is unable to express himself or herself age-
appropriately. Speech (or crying for babies) is absent or abnormal. As with
lack of crying in infants, this can be a sign of an occluded airway .
Normal: The child expresses himself or herself age-appropriately. Speech
(crying) is normal (this is a reliable sign of a clear airway) .
Once we have a basic snapshot of appearance, breathing and circulation we
can combine the elements to help determine both how unwell the child is and
what could be wrong with them.
Respiratory distress
A child who is exhibiting increased work of breathing, but has normal
appearance and circulation to skin, can be initially assumed to be in
respiratory distress, While the child is having trouble breathing, he or she is
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