High-yield approach to the most common pediatric ED chief complaints. Use age + appearance (PAT — Pediatric Assessment Triangle: Appearance, Work of Breathing, Circulation) to triage every child within seconds of room entry.
🚩 Red-flag clues (must not miss)
- •Toxic appearance, mottling, delayed cap refill > 3 s
- •Bilious vomiting at any age = malrotation/volvulus until proven otherwise
- •Fever in infant < 28 days = full sepsis workup, no exceptions
- •Petechiae below the nipple line + fever = meningococcemia until excluded
- •Bulging fontanelle, paradoxical irritability when held = meningitis
History
- Birth history, prematurity, maternal GBS / HSV / fever
- Immunization status (esp. Hib, PCV, MenB, rotavirus)
- Feeding pattern, wet diapers, weight trajectory
- Sick contacts, daycare, recent travel, antibiotic exposure
Exam
- Vitals interpreted by age — tachycardia is the earliest sign of shock in kids
- PAT: Appearance, Work of Breathing, Circulation
- Full skin exam (undress the infant) — petechiae, bruising, rash
- Anterior fontanelle, sutures, head circumference (< 2 y)
Pearls
- Children compensate well, then crash — trust tachycardia and poor perfusion before hypotension.
- Always weigh in kg only; use length-based tape if no scale.
- Document hydration status (mucous membranes, tears, cap refill, fontanelle).
Source: https://fprmed.com/fprmedcom/Pages/Pedi/Pedi_ED_Complaints.html
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