Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Life-threatening first impression
Abnormal appearance with severe breathing or circulatory signs can precede bradycardia and cardiac arrest in children.
Action: Call the paediatric emergency or resuscitation team, move to a monitored resuscitation area and begin ABCDE immediately. Open and position the airway, give high-concentration oxygen for critical illness, support ventilation, obtain vascular access without repeated delay and treat shock, hypoglycaemia, seizure or anaphylaxis as identified. Reassess from A after every intervention and prepare early for senior airway and critical-care support.
Synopsis
Use a rapid visual assessment to identify physiological threat, then perform structured ABCDE resuscitation with age-appropriate interventions and repeated response checks.
The Paediatric Assessment Triangle is a no-equipment first look at appearance, work of breathing and circulation to skin, completed in seconds before hands-on ABCDE.
PAT identifies a physiological pattern and urgency; it does not provide a diagnosis, replace observations or delay resuscitation.
Abnormal work of breathing with preserved appearance suggests respiratory distress; abnormal appearance as effort fails suggests respiratory failure.
Key red flags
Reduced responsiveness, poor tone, absent interaction, weak cry or inability to maintain posture indicates abnormal appearance and possible respiratory or circulatory failure.
Investigation priorities
01
First-line: Paediatric Assessment TriangleFirst stepFirst line
Identify severity and physiological domain within seconds without touching the child.
02
First-line: continuous observationsFirst line
Track oxygenation, heart rate, respiratory rate, blood pressure, temperature and consciousness.
Management branches
Doorway assessmentPAT before contact
A child is first seen in any acute setting.
Observe appearance, work of breathing and circulation to skin without disturbing the child.
Name the physiological pattern and decide whether resuscitation-team activation is immediate.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.