PALS Provider: Course

Pediatric Assessment Triangle (PAT)

The Pediatric Assessment Triangle (PAT) is a rapid, visual assessment tool used to quickly evaluate a child’s condition within seconds—without the need for equipment or vital signs. It is an essential first step in pediatric emergency care, helping determine the severity of illness or injury before a detailed exam.

PAT is based on three key observations that allow healthcare providers to immediately recognize life-threatening conditions and prioritize interventions.

Why Use PAT?

  • Fast and non-invasive—takes only seconds to assess.
  • No equipment required—based entirely on observation.
  • Guides immediate management—helps determine if the issue is respiratory, circulatory, or both.

The Three Components of the Pediatric Assessment Triangle

PAT focuses on three observations: Appearance, Work of Breathing, and Circulation to Skin.

1. Appearance – “Is the child acting normally?”

Appearance reflects neurological function and overall condition. A child’s behavior and interaction often point to respiratory, circulatory, or metabolic problems.

Key Features of Normal Appearance (TICLS mnemonic):

  • Tone: Is the child moving normally or limp?
  • Interactiveness: Is the child alert and engaging?
  • Consolability: Can the child be comforted by a caregiver?
  • Look/Gaze: Is there eye contact or a blank stare?
  • Speech/Cry: Is it strong and appropriate for age?

Abnormal Findings:

  • Lethargy, irritability, or unresponsiveness → Suggests shock, sepsis, or metabolic issues.
  • Poor tone, weak cry, or lack of eye contact → Possible hypoxia, brain injury, or severe illness.

Clinical Implications:

  • Abnormal appearance = immediate intervention required.
  • Altered mental status often signals worsening hypoxia or shock.

2. Work of Breathing – “How hard is the child trying to breathe?”

Work of breathing assesses respiratory effort and effectiveness. Early detection is critical, as respiratory failure is the most common cause of pediatric arrest.

Key Observations:

  • Visible retractions (subcostal, intercostal, suprasternal)
  • Abnormal breath sounds (stridor, wheezing, grunting)
  • Nasal flaring or head bobbing (signs of distress)
  • Irregular or absent breathing (apnea or gasping)

Abnormal Findings:

  • Stridor: Upper airway obstruction (e.g., croup, epiglottitis)
  • Wheezing: Lower airway obstruction (e.g., asthma, bronchiolitis)
  • Grunting: Suggests alveolar collapse or lung disease
  • Diminished breath sounds: Possible respiratory failure

Clinical Implications:

  • Abnormal findings require immediate oxygenation and ventilatory support.
  • Progression to fatigue = impending respiratory failure.

3. Circulation to Skin – “Is perfusion adequate?”

This observation assesses the child’s circulatory status—early recognition of shock is essential.

Key Observations:

  • Pallor (pale skin)
  • Mottling (patchy skin discoloration)
  • Cyanosis (bluish color, especially lips and central areas)
  • Cool extremities, delayed capillary refill, weak pulses

Abnormal Findings:

  • Pallor + tachycardia → Early shock
  • Mottling or cold extremities → Worsening perfusion
  • Cyanosis → Severe hypoxia or circulatory collapse

Clinical Implications:

  • Pallor and delayed cap refill = early shock → treat immediately.
  • Cyanosis = critical state → urgent oxygenation and fluid support needed.

Interpreting PAT Results

PAT Findings Likely Condition Examples
Abnormal Appearance + Normal Breathing + Normal Circulation CNS or Metabolic Sepsis, hypoglycemia, poisoning
Normal Appearance + Abnormal Breathing + Normal Circulation Respiratory Asthma, croup, pneumonia
Normal Appearance + Normal Breathing + Abnormal Circulation Circulatory Dehydration, sepsis, anaphylaxis
Abnormal in 2+ Categories Critical/Combined Failure Impending arrest, severe shock

Key Actions Based on PAT:

  • Respiratory distress → Ventilatory support, airway adjuncts, oxygen.
  • Shock symptoms → IV fluids, vasopressors, and treat the cause.
  • Altered mental status → Evaluate for hypoxia, sepsis, or metabolic causes.

Why PAT Is a Game-Changer in Pediatric Emergencies

  • Enables rapid triage of stable vs. unstable patients.
  • Can be used anywhere—no tools needed.
  • Guides treatment priorities instantly.
  • Improves team communication with a shared framework.

Summary: PAT in Action

  • Appearance: Is the child acting normally?
  • Work of Breathing: Is there increased effort?
  • Circulation to Skin: Is perfusion adequate?

PAT is a first-line triage tool that categorizes pediatric emergencies by cause—respiratory, circulatory, or neurologic/metabolic—and helps prioritize early interventions.

Takeaway: In pediatrics, seconds matter. PAT helps providers make life-saving decisions—fast.