Pediatric Early Warning System (C&V PEWS)

Birthdate (enter MM//DD/YY)

Date of evaluation (enter MM/DD/YY)

Is there a threat to the airway (stridor, etc)?

Does the patient have abnormal respirations (recession, use of accessory muscles, etc)?

Respiratory rate

Does the patient need for supplemental oxygen to keep the oxygen saturation greater than 90%?

Heart rate

Systolic blood pressure

Is the health care provider worried about the patient’s clinical state?

Patient's level of consciousness