Paediatric physiological discriminators (PPD)

The following tables provide the criteria for PPD, including disability.

PPD	Category 1 Immediate	Category 2 Emergency Within 10 minutes	Category 3 Urgent within 30 minutes	Category 4 Semi-urgent Within 60 minutes	Category 5 Non-urgent Within 120 minutes
Airway	Obstructed Partially obstructed with severe respiratory distress	Patent Partially obstructed with moderate respiratory distress	Patent Partially obstructed with mildrespiratory distress	Patent	Patent
Breathing	Absent respiration or hypoventilation	Respiration present	Respiration present	Respiration present	Respiration present
Circulation s/s dehydration *	Severe respiratory distress, e.g. severe use of accessory muscles severe retraction acute cyanosis	Moderate respiratory distress, e.g. moderate use of accessory muscles moderate retraction skin pale	Mild respiratory distress, e.g. mild use of accessory muscles mild retraction skin pink	No respiratory distress, e.g. no use of accessory muscles no retraction	No respiratory distress, e.g. no use of accessory muscles no retraction
Circulation s/s dehydration *	Absent circulation Severe bradycardia, e.g. HR <60 in an infant	Circulation present	Circulation present	Circulation present	Circulation present
Circulation s/s dehydration *	Severe haemodynamic compromise, e.g. absent peripheral pulses skin pale, cold, moist, mottled significant tachycardia capillary refill >4 secs	Moderate haemodynamic compromise, e.g. weak/thready brachial pulse skin pale, cool moderate tachycardia capillary refill 2-4 secs	Mild haemodynamic compromise, e.g. palpable peripheral pulses skin pale, warm mild tachycardia	No haemodynamic compromise, e.g. palpable peripheral pulses skin pale, warm	No haemodynamic compromise, e.g. palpable peripheral pulses skin pale, warm
Circulation s/s dehydration *	Uncontrolled haemorrhage	> s/s dehydration	3-6 s/s dehydration	<3 s/s dehydration	No s/s dehydration

* Signs/symptoms dehydration:
↓ LOC/activity, cap refill >2 sec, dry oral mucosa, sunken eyes.
↓ tissue turgor, absent tears, deep respirations, thready/weak pulse/tachycardia.
↓ urine output.

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PPD	Category 1 Immediate	Category 2 Emergency Within 10 minutes	Category 3 Urgent within 30 minutes	Category 4 Semi-urgent Within 60 minutes	Category 5 Non-urgent Within 120 minutes
Disability	GCS <8	GCS 9-12 Severe decrease in activity, e.g. no eye contact decreased musle tone Severe pain, e.g. patient/parents report severe pain skin pale, cool alteration in vital signs requests analgesia Severe neurovascular compormise, e.g. pulseless cold nil sensation nil movement ↓ capillary refill	GCS >13 Moderate decrease in activity, e.g. lethargy eye contact wihen disturbed Moderate pain, e.g. patient/parents report moderate pain skin pale, warm alteration in vital signs requests analgesia Moderate neurovascular compormise, e.g. pulse present cool sensation movement ↓ capillary refill	Normal GCS or no acute change to usual GCS Mild decrease in activity, e.g. quiet but eye contact interacts with parents Mild pain, e.g. patient/parents report mild pain skin pink, warm no alteration in vital signs requests analgesia Mild neurovascular compormise, e.g. pulse present normal/↓ sensation normal/↓ movement normal capillary refill	Normal GCS or no acute change to usual GCS No alteration in activity, e.g. playing smiling No or mild pain, e.g. patient/parents report mild pain skin pink, warm no alteration in vital signs declines analgesia No neurovascular compormise

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