Patient Assessment and Stabilization for Transport
The first 30 seconds
Begin with the Pediatric Assessment Triangle - appearance, work of breathing, and circulation to skin - before touching equipment. Appearance (tone, interactiveness, consolability, look/gaze, cry) is the most sensitive single indicator of serious illness in infants and children. Then complete ABCDE with age-appropriate vital signs; a term neonate normally breathes 40–60/min with awake heart rates of 120–160, while adolescents approximate adult norms.
Stabilize before you move
Transport doctrine is "stay and stabilize," not scoop-and-run: secure the airway with a correctly sized device, obtain vascular access, begin fluid or pressor support, control temperature, and correct glucose before wheels-up. Weight drives everything - use a measured weight when available, otherwise a length-based tape - because every drug, bolus, and tube size is weight-based.
Traps
Questions reward recognition that hypotension is a late sign: a child in compensated shock maintains pressure through tachycardia and vasoconstriction, then decompensates abruptly. Neonatal bradycardia is usually hypoxic and is treated with ventilation, not atropine. Do not let one dramatic number distract from the secondary survey; missed coexisting injuries and missed lines are classic transport failures. A complete handoff (SBAR or I-PASS) covering allergies, medications, access, and pending studies belongs before departure.
Worked example
A 3-month-old with HR 210, capillary refill 4 seconds, mottling, and a normal blood pressure has compensated shock - give 10–20 mL/kg isotonic crystalloid and reassess rather than waiting for the pressure to fall.