PEDIATRIC ASSESSMENT TRIANGLE

Shinta Nareswari
APPEARANCE : THE “TICKLES” (TICLS) MNEMONIC
Characteristic Normal Features
Tone Move spontaneously, resist
examination, sits or stands (age
appropriate)
Interactiveness Appears alert/engaged with clinician
or caregiver, interacts well with
people/environment, reaches for
objects
Consolability Stops crying with holding/comforting
by caregiver, has differential
response to caregiver vs examiner
Look/gaze Makes eye contact with clinician,
tracks visually
Speech/cry Use age-appropriate speech
WORK OF BREATHING
Characteristic Abnormal Features
Abnormal airway sounds Snoring, muffled/hoarse speech,
stridor, grunting, wheezing
Abnormal positioning Sniffing position, tripoding, prefers
seated posture
Retractions Supraclavicular, intercostal, or
substernal, head bobbing
Flaring Flaring of the nares on inspiration
CIRCULATION TO SKIN
Characteristic Abnormal Features
Pallor White/pale skin or mucous
membranes
Mottling Patchy skin discoloration due to
variable vasoconstriction
Cyanosis Bluish discoloration of skin/mucous
membranes
PAT GENERAL IMPRESSION

STABLE

Appearance Work of Breathing

Circulation to skin
PAT GENERAL IMPRESSION

RESPIRATORY
DISTRESS

Appearance Work of Breathing

Circulation to skin
PAT GENERAL IMPRESSION

RESPIRATORY
FAILURE

Appearance Work of Breathing

Circulation to skin
PAT GENERAL IMPRESSION

SHOCK

Appearance Work of Breathing

Circulation to skin
PAT GENERAL IMPRESSION

SHOCK

Appearance Work of Breathing

Circulation to skin
PAT GENERAL IMPRESSION

CNS/METABOLIC

Appearance Work of Breathing

Circulation to skin
PAT GENERAL IMPRESSION

CARDIOPULMONARY
FAILURE

Appearance Work of Breathing

Circulation to skin
REFERENSI
 Dieckmann R, Brownstein D, Gausche-Hill M.
The pediatric assessment triangle: a novel
approach for the rapid evaluation of children.
Pediatr Emerg Care. 2010; 26(4):312-5
doi: 10.1097/PEC.0b013e3181d6db37