This reference card should not be considered to replace or supercede regional prehospital medical treatment protocols.
Supported in part by project grant #6 H33 MC 00036 from the Emergency Services for Children program, HRSA, USDHHS in cooperation with NHTSA Rev. 1/04
General Impression
(First view of patient)
Airway & Appearance
(Open/Clear – Muscle Tone /Body Position)
Abnormal: Abnormal or absent cry or speech.
Decreased response to parents or environmental stimuli.
Floppy or rigid muscle tone or not moving. AB
Normal: Normal cry or speech. Responds
to parents or to environmental stimuli such as
lights, keys, or toys. Good muscle tone. C
Moves extremities well. Circulation to Skin
Work of Breathing
(Visible movement / Respiratory Effort)
Abnormal: Increased/excessive (nasal flaring,
retractions or abdominal muscle use) or
decreased/absent respiratory effort or noisy
breathing.
Normal: Breathing appears regular
without excessive respiratory muscle effort
or audible respiratory sounds.
(Color / Obvious Bleeding)
Abnormal: Cyanosis, mottling, paleness/pallor or obvious significant bleeding.
Normal: Color appears normal for racial group of child. No significant bleeding.
Decision/Action Points:
• Any abnormal findings or life-threatening chief complaint such as major trauma/burns, seizures, diabetes, asthma attack,
airway obstruction, etc (urgent) – proceed to Initial Assessment. Contact ALS if ALS not already on scene/enroute.
• All findings normal (non-urgent) – proceed to Initial Assessment.
Initial Assessment
(Primary Survey)
Airway & Appearance
(Open/Clear – Mental Status)
Abnormal: Obstruction to airflow.
Gurgling, stridor or noisy breathing.
Verbal, Pain, or Unresponsive on AVPU scale.
Normal: Clear and maintainable. Alert on Continue assessment
AVPU scale. throughout transport
Breathing
(Effort / Sounds / Rate / Central Color)
Abnormal: Presence of retractions, nasal
flaring, stridor, wheezes, grunting, gasping or
gurgling. Respiratory rate outside normal
range. Central cyanosis.
Normal: Easy, quiet respirations. Respiratory
rate within normal range. No central cyanosis.
Circulation
(Pulse Rate & Strength / Extremity Color & Temperature / Capillary Refill / Blood Pressure)
Abnormal: Cyanosis, mottling, or pallor. Absent or weak peripheral or central pulses; Pulse or systolic BP outside normal
range; Capillary refill > 2 sec with other abnormal findings.
Normal: Color normal. Capillary refill at palms, soles, forehead or central body ≤ 2 sec. Strong peripheral and central
pulses with regular rhythm.
Decision/ Action Points:
• Any abnormal finding (C, U, or P)– Immediate transport with ALS. If ALS is not immediately available, meet ALS
intercept enroute to hospital or proceed to hospital if closer. Open airway & provide O2. Assist ventilations, start CPR,
suction, or control bleeding as appropriate. Check for causes such as diabetes, poisoning, trauma, seizure, etc.
Assist patient with prescribed bronchodilators or epinephrine auto-injector, if appropriate.
• All findings on assessment of child normal (S)– Continue assessment, detailed history & treatment at scene or enroute.
Normal Respiratory Rate: Normal Pulse Rate: Lower Limit of Normal Systolic BP:
Infant (<1yr): 30- 60 Infant: 100-160 Infant: >60 (or strong pulses)
Toddler (1-3yr): 24 -40 Toddler: 90-150 Toddler: >70 (or strong pulses)
Preschooler(4-5yr): 22- 34 Preschooler: 80-140 Preschooler: >75
School-age(6-12yr): 18 -30 School-age: 70-120 School-age: >80
Adolescent(13-18yr): 12 -20 Adolescent: 60-100 .Adolescent: >90
Pulses slower in sleeping child / athlete Estimated min.SBP >70 + (2 x age in yr)
PEDIATRIC ASSESSMENT
