EMT · Primary Assessment · 6 min read
Pediatric and Geriatric Primary Assessment
- Identify critical pediatric respiratory and circulatory compromise using the Pediatric Assessment Triangle and anatomical airway considerations.
- Recognize early versus late signs of shock and respiratory failure across pediatric and geriatric age groups.
- Adapt primary assessment techniques for geriatric patients by accounting for altered baseline cognition, chronic conditions, and blunted physiological responses.
The Pediatric Assessment Triangle and Across-the-Room Survey
The primary assessment of a child begins the moment you enter the room, well before you touch the patient or reach for diagnostic tools. The Pediatric Assessment Triangle is a rapid, visual, across-the-room evaluation performed before touching the patient. Approaching an ill child abruptly can trigger crying and agitation, which obscures baseline breathing and vital cues. By observing from a brief distance first, you gather vital information about the child's physiological stability while the patient remains calm.
The three components of the Pediatric Assessment Triangle are appearance, work of breathing, and circulation to the skin. The appearance component assesses oxygenation, brain perfusion, and central nervous system function. To evaluate appearance, EMTs use the mnemonic TICLS, which represents Tone, Interactiveness, Consolability, Look or gaze, and Speech or cry. A child who is limp, fails to interact with caregivers, cannot be comforted, lacks an engaged gaze, or has an abnormal cry is demonstrating compromised appearance.
The remaining two arms of the triangle focus on respiratory effort and systemic perfusion. Work of breathing in the Pediatric Assessment Triangle reflects the child's muscular effort to oxygenate and ventilate. Circulation to the skin uses visible signs such as pallor, mottling, and cyanosis to assess possible problems with perfusion or oxygenation. Together, these three visual components establish your immediate general impression and direct your rapid life-saving priorities.
Common mistakes
- Assuming a slowing respiratory rate in an infant with respiratory distress means the patient is improving, rather than recognizing bradypnea as an ominous sign of exhaustion and impending arrest.
- Removing firmly fitting dentures during basic airway management, which collapses facial structure and makes achieving a tight bag-valve-mask seal far more difficult.
- Relying solely on capillary refill time or skin turgor to diagnose dehydration or shock in geriatric patients, ignoring the confounding effects of chronic vascular disease and reduced skin elasticity.
- Forcing a patient with thoracic kyphosis completely flat onto a backboard instead of using padding to support their natural alignment, which can compromise the airway.
Key points
- The visual Pediatric Assessment Triangle evaluates appearance (TICLS), work of breathing, and circulation to the skin before touching the patient.
- Pediatric airway anatomy requires careful positioning; place padding under the shoulders if needed to achieve a neutral airway position without flexing or hyperextending the neck.
- Infants exhibit distress through grunting, head bobbing, and seesaw breathing, with bradypnea serving as an ominous sign of impending respiratory arrest driven by hypoxia.
- Tachycardia is a common early sign of pediatric shock, while hypotension is a late finding and bradycardia in a critically ill child is ominous.
- In geriatric patients, leave firm dentures in place for mask seals, remove loose dentures, and pad beneath kyphotic curvatures during spinal motion restriction.
- Aging blunts cough and gag reflexes, chemoreceptor sensitivity, and tachycardic responses to shock, making tachypnea a crucial early marker of severe systemic illness.
- Assess geriatric mental status against their baseline, recognizing that acute delirium fluctuates suddenly, dementia is progressive, and hypoglycemia can cause focal neurologic deficits.
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