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.
- Abnormal skin circulation with preserved appearance suggests compensated shock; abnormal appearance or hypotension indicates decompensation.
- Start ABCDE with airway patency and position; use neutral positioning in infants and slight extension in older children while protecting the cervical spine when indicated.
- For breathing, assess rate, effort, air entry, chest movement, saturation and signs of exhaustion; give oxygen and assist ventilation when effort is inadequate.
- For circulation, assess heart rate, central and peripheral pulses, capillary refill, skin temperature, blood pressure, urine and mental state; obtain IV or intraosseous access according to urgency.
- Give a 10 mL/kg isotonic crystalloid bolus for paediatric shock under current UK pathways, reassess immediately and use smaller or cautious aliquots in cardiac or renal disease.
- For disability, assess AVPU or Glasgow Coma Scale, pupils, posture, seizure and bedside glucose; treat hypoglycaemia and seizures promptly.
- For exposure, examine fully while preserving dignity and temperature, looking for rash, injury, bleeding, swelling, medical devices and safeguarding findings.
- Treat each life threat when found rather than completing the alphabet first, and repeat ABCDE from the beginning after every intervention or deterioration.
- Use weight in kilograms, age-adjusted equipment and independent dose checks; if weight is unavailable in a true emergency, use an approved length-based system.
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.
Apnoea, gasping, silent chest, exhaustion, cyanosis, severe recession or falling respiratory effort is respiratory failure rather than simple distress.
Bradycardia in an unwell child commonly reflects severe hypoxia and is a peri-arrest sign requiring immediate oxygenation and ventilation support.
Cool mottled skin, prolonged capillary refill, weak central pulses, reduced urine, altered mental state or hypotension indicates shock; hypotension is late.
A caregiver saying the child is rapidly worsening, or a repeated assessment that has changed, should trigger escalation even when the first score was low.
Investigation priorities
Identify severity and physiological domain within seconds without touching the child.
Track oxygenation, heart rate, respiratory rate, blood pressure, temperature and consciousness.
Management branches
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.
- Move directly to hands-on ABCDE, monitoring and age-appropriate equipment when any domain is abnormal.