Emergency Triage Education Kit | Page 56

Circulation

Hypotension is a very late sign of haemodynamic compromise in infants and children. Initial assessment should be dependent upon general appearance, pulse and central capillary refill.

• Onset of pallor in infants is a significant finding and an indicator of serious illness.

• Capillary refill time is an indicator of central perfusion and therefore an indirect measure of cardiovascular function.

• Estimation of the level of dehydration is important – see Table 8.1.

Table 8.1: Assessment of dehydration levels in infants 142

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Signs

General condition Thirsty, restless, agitated

Severity Mild Moderate Severe

Thirsty, restless, irritable

Withdrawn, somnolent or comatose; rapid deep breathing

Disability

An abnormal conscious level always requires urgent assessment. An alteration in the level

82, 95 of activity can be an indicator of serious illness in infants and children.

Decreased conscious level can be a result of serious derangement of oxygenation or circulation.

The different developmental levels of children will complicate conscious state and neurological assessment. The AVPU scale is a good method to assess level of consciousness at triage.

Never underestimate the contribution of the parents or carer. They will often be able to identify subtle deviations from normal which you may not be able to detect clinically.

Pain assessment should also form a component of the neurological assessment. Assessment of pain in children may require adaptation of pain measurement tools, and will be dependent on the child’ s age. For example, behavioural tools would be appropriate for pre-verbal children,

113, 114 faces scales for early verbal children and visual analogue scales for older children.

Department of Health and Ageing – Emergency Triage Education Kit