Paediatric monitoring and response chart. Name. UR Number. Age: Paediatric monitoring and response chart Name UR Number Age: Weight: Length / height Diagnoses: Frequency of observations: Date   Time Temp °C ≥ 39 >39 38-38.9 36-37.9 <36 AIRWAY / BREATHING Respiratory Rate (bpm) ≥ 80 70 60 50 40 30 20 10 SpO2 (%) 95-100 90-95 80-90 70-80 <70 Oxygen L/min Respirat distress Severe Mod. Mild Normal CIRCULATION Heart rate (bpm) ≥ 200 190 180 170 160 150 140 130 120 100 90 80 <60 Cap refill ≥ 3 secs < 3 secs BP Systolic Diastolic Mean DISABILITY AVPU response to stimuli Alert Verbal Pain None Pain score ( /10) Blood sugar level Treatments given Actions taken 

Instructions on the use of Paediatric monitoring and response chart Specify frequency of observations: hourly, 2nd hourly, 4th hourly, etc Use the chart to record vital observations on every patient Record all vital observations, including oxygen saturation and blood pressure on admission and thereafter When graphing observations, place a dot in the box and connect it to the previous dot with a straight line. For SpO2 and Temperature write the exact number in the appropriate section, e.g. 87%, or 38.5. Respond to all observations in the red and orange zones Respond if an observation is deteriorating Mandatory emergency call for: Any observations in the red zone, OR Airway obstruction or severe stridor Apnoea or cyanosis on oxygen, or severe respiratory distress, or SpO2 or RR in red zone Cardiac or respiratory arrest, or HR or BP in red zone Sudden deterioration in conscious state or seizures Staff are very worried about the clinical state of the child If more than 2 observations in the Orange zone, call a doctor to review, or call a MET