This post presents a tool for the rapid assessment of the cardiopulmonary status and cerebral/metabolic function of critically ill pediatric patients. The purpose is not to establish a diagnosis, rather to identify the particular physiological derangements to prioritize initial interventions. The tool was initially designed as a “triangle” – it has been adapted here (with permission) as a Venn diagram.¹

Pediatric Assessment Diagram

Assessment of Appearance

• Tone: Moves spontaneously, resists examination
• Interactivity: Interacts with environment, reaches for items
• Consolability: Comforted by caregiver
• Gaze: Makes eye contact

Assessment of Work of Breathing

• Airway Sounds: Stridor, grunting, wheezing
• Position: Tripod
• Retractions

Assessment of Circulation

• Pallor
• Mottling
• Cyanosis

Management

Impression	Interventions
Respiratory distress	Position of comfort Oxygen, suction Therapy as appropriate (albuterol, epinephrine, etc) Labs/radiographs as indicated
Respiratory failure	Head/airway positioning 100% oxygen Ventilation support (BVM) Advanced airway
Shock (compensated and decompensated)	Oxygen Access Fluid resuscitation Specific therapy (antibiotics, surgery) Labs/radiographs as indicated
CNS/Metabolic	Pulse oximetry Rapid glucose Labs/radiographs as indicated
Cardiopulmonary Failure	Head/airway positioning 100% oxygen Ventilation support (BVM) Chest compressions as needed Specific therapy (defibrillation, epinephrine, amiodarone) Labs/radiographs as indicated

References:

1. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26(4):312-315. doi:10.1097/PEC.0b013e3181d6db37.