Canadian Triage and

Acuity Scale

PEDIATRIC
:PRESENTED BY
DR. ELSAYED ELKENANY
E.D. SPECIALIST
HEAD of EMERGENCY DEPARTMENT

?To Whom Does PedCATS Apply To

Birth and including 16 years

of age
Challenged and technologydependent individuals older
than 16

?Why was PedCTAS Developed

Children differ from

Pediatric Considerations

1. Pediatric Size

Pediatric Considerations

2. Pediatric
Development

Pediatric Considerations

3. Cultural/Familial
Influence

Components of Pediatric Triage

The Pediatric Assessment Triage (Critical

Look)
Initial Assessment

Appearance/neurological assessment

Respiratory and effort

Heart rate and perfusion

History
Triage Decision (2 to 5 minute
assessment)

PEDIATRIC ASSESSMENT
APPERANCE
Dress (appropriate for the season)
Activity (more/less than for a child that
age)
Speech/Cry (message of
pain/discomfort/fear)
AIRWAY & BREATHING
Drooling/Dysphagia
Position (tripod)
Adventitious Sounds (stridor, wheezing,
grunting)

PEDIATRIC ASSESSMENT
CIRCULATON
Pallor
Cyanosis
Tachycardia/bradycardia
Absent peripheral pulse
DISABILITY
Altered level of consciousness
Papillary changes
Irritability
Restlessness

PEDIATRIC VITAL SIGNS

MAY BE REQUIRED FOR SPECIFIC
TRIAGE ASSESSMENT

TEMPERATURE
OXYGEN SATURATION
PAIN
WEIGHT
BLOOD PRESSURE

PEDIATRIC VITAL SIGNS

TEMPERAT
URE

PEDIATRIC VITAL SIGNS

PAIN
Intense pain can be associated with benign
processes (otitis media)
Tachycardia, pallor, sweating and other
physiological signs are useful in the
evaluation of pain level
Past experience
Pain scale are less helpful at the extremes of
age

PEDIATRIC VITAL SIGNS

PAIN
How accurate is the parental impression of
their child's pain?
Do younger children receive analgesic as often
as older children even if they report their pain
as moderate to severe?
How would you assess pain in a neonate or
young infant?
The younger the child the less likely a pain
score is documented

The F.L.A.C.C Score

PEDIATRIC CTAS: NORMAL VITAL SIGNS

A triage trick to remembering

Vital Signs Norms in Children:
Use a standard chart
Memorize that a neonate pulse is 140 bpm,
pull out the 40 as normal for respiration.
In each sequential age group (2-4), child (510), Adult the decreased by 20, RR
decreased by 10
A 2 year old HR 120, RR 30
A 5 year old HR 100, RR 20

PEDIATRIC CTAS

C chief Complaint
I immunization
A allergies
M medications
P past medical history/parents perception of
child's condition

E events sounding the illness or

injury
D diet/diapers

PEDIATRIC ASSESSMENT
DEHYDRATION

MILD DEHYDRATION
Normal Blood Pressure
Dry Mouth

MODERATE DEHYDRATION
Dry Cracked Lips
Some Mottling of the Skin
Normal Blood Pressure

SEVERE DEHYDRATION
Cool Extremities
Delayed Capillary Refill
Totally Parched
Hypotension
Central Cyanosis

Patient should have an INITIAL

TRIAGE ASSESSMENT WITHIN
10 MINUTES of arrival

Patient should have an INITIAL

TRIAGE ASSESSMENT WITHIN
10 MINUTES of arrival

Patient should have an INITIAL

TRIAGE ASSESSMENT WITHIN
10 MINUTES of arrival

Patient should have an INITIAL

TRIAGE ASSESSMENT WITHIN
10 MINUTES of arrival

TRIAGE LEVEL V NON URRGENT

Patient should have an INITIAL

TRIAGE ASSESSMENT WITHIN
10 MINUTES of arrival
TIME TO NURSE
ASSESSMENT:
120 MINUTES
TIME TO NURSE
REASSESSMENT
120 MINUTES
TIME TO
PHYSICIAN
ASSESSMENT/
INITIATION OF
TREATMENT:
120 MINUTES

EXAMPLES
1. CHILD WHO IS ALERT
AFEBRILE, WELL
HYDRATED, NORMAL VS
2. VOMITING/DIARRHEA
ALONE WITH NO SIGNS
OF DEHYDRATION
3. ACUTE BUT NON
URGENT
4. PART OF A CHRONIC
PROBLEM WITHOUT
DETERIORATION

CONDITION THAT
MAY BE ACUTE BUT
NON URGENT AS
WELL AS
CONDITIONS WHICH
MAY BE PART OF A
CHRONIC PROBLEM
WITH OR WITHOUT
DETERIORATIOB