Disability: Responsive to pain
Tone and posture: abnormal
Eyes: conjugate deviation+nystagmus+, no lid twitch, pupils equal and reactive to light
Embedded Image Airway: unstable
Breathing: RR 60 BPM, grunt+, no stridor, retractions+, abdomino-thoracic respiration+, bilateral air-entry+, crepitation+
Circulation: heart rate 120 BPM
Heart sounds: muffling+, no gallop, warm peripheries
Pulses: +++/+++, flushed, CRT<2 s
Liver span: 8 cm firm
SBP: 90 mm Hg
DBP: 0 mm Hg
Pulse Pressure: > 40 mmHg
MAP: 30 mm Hg
Summary: physiological status using the PREM triangle
Airway: unstable
Breathing: impending respiratory failure
Circulation: relative bradycardia, vasodilatory shock, cardiac dysfunction, SBP high, wide pulse pressure, low MAP
Disability: altered level of consciousness, non-convulsive status epilepticus
  • Adapted from the National Health Mission-Strengthening of Pediatric Emergency Care System in Tamil Nadu-Establishment of Pediatric Resuscitation and emergency Units under Tamil Nadu Accidents and Emergency Care Initiative under the name of PREM G.O(D)No. 539, Department of Health and Family Welfare, dated 30 November 2019.

  • BPM, beats per minute; CRT, capillary refill time; DBP, diastolic blood pressure; MAP, mean arterial pressure; PREM, Pediatric Resuscitation and Emergency Medicine; RR, respiratory rate; SBP, systolic blood pressure.