Last Updated on August 19, 2026
Triaging in ED
Primary triage
•
GCS
• Child responds to call? Glasgow Coma Scale (GCS) • Oral intake as usual? Dehydration • e.g. Hand, foot, and mouth disease (HFMD), Chickenpox
• Child obeys commands as usual
Open: https://www.myhouseman.my/glasgow-coma-scale-gcs/
• The child is in
dehydration
• Diaper change as usual? Diapers heavy as usual?
•
Infectious
• May require isolation
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💡 One the most important things at triage level is to determine whether the child is stable
Differential Diagnoses
Some common causes:
Infectious:
• Hand, foot and mouth disease
• Measles
• Herpes simplex virus infection
• Chikungunya
• Chickenpox
Non-infectious:
• Meningitis
• Stevens-Johnson syndrome /
• Dengue
• Kawasaki disease
History Taking
Rash
•
Onset
Mnemonic: Very Sick Person Must Take Double Tablets • Caudal to cranial?
• Varicella (chickenpox) – Day 1
• Scarlet fever – Day 2
• Pox i.e. Small pox – Day 3
• Measles – Day 4
• Typhus – Day 5
• Dengue – Day 6
• Typhoid – Day 7
• Type of rash
• Distribution
•
Spread / Progression of rash
• Cranial to caudal? suggestive of measles
Relevant history
• Sick contact? e.g. allergic reaction to paracetamol causing Stevens Johnson syndrome
• Allergy history
• Recent history of taking
new medications
Physical Examination
Assessment of hydration status:
General appearance | Well | Unwell | Unwell / Deteriorating | Unwell / Deteriorating |
Consciousness | Alert & responsive | Restless / irritable | Lethargic / unconscious | Lethargic / unconscious |
Sunken eyes | Absent | Present | Present | Present - grossly sunken eyes |
Skin turgor | Normal (i.e. brisk // immediate) | Reduced (≤2 seconds) | Reduced (>2 seconds) | Reduced (>2 seconds) |
Offer Fluid | Drinks normally | Drinks eagerly | Unable to drink / Drinks poorly | Unable to drink / Drinks poorly |
Notes | ||||
Other parameters used for hydration assessment: • CRT greater than 2 seconds CCTVR — to assess features of shock by touching the peripheries C: Color → Pale / mottled skin C: CRT → CRT >2s T: Temperature → Cold V: Pulse Volume → Weak R: Pulse Rate → Tachycardia Related Posts: • CRT greater than 2 seconds CCTVR — to assess features of shock by touching the peripheries C: Color → Pale / mottled skin C: CRT → CRT >2s T: Temperature → Cold V: Pulse Volume → Weak R: Pulse Rate → Tachycardia Related Posts:
• Color of skin
• CRT
• Temperature of peripheries – warm / cold
• Pulse volume
• Pulse rate — tachycardia / normal heart rate
Any signs of shock?
• Compensated shock —
CCTVR
• Pale / mottled skin color
• Cold peripheries
• Poor pulse volume
• Tachycardia
• Decompensated shock —
CCTVR
• Pale / mottled skin color
• Cold peripheries
• Poor pulse volume
• Tachycardia
References / Further Reading
- Day of appearance of rash in febrile patients [link]
Take Home Message
1. At ED, it’s important to determine if the child is stable and whether resuscitation is required
2. Children unlike adults, can deteriorate very fast
3. Always remember to ask regarding oral intake and diapers change frequency to evaluate hydration status