After airway and breathing have been assessed, an evaluation of the patient's circulation and perfusion should be performed. A well perfused patient should have warm, dry skin, strong peripheral pulses and capillary refill less than two seconds. Initially, assess the peripheral pulse for rate and quality. If the peripheral pulse is absent, check the central pulse, such as the brachial, femoral or carotid. A rapid assessment of skin color, remperature and moisture, along with the capillary refill also aids in determining the perfusion status of the child. Critical interventions at this point include immediately addressing any uncontrolled hemorrhage and splinting pelvic and long bone fractures that can lead to large amounts of blood loss into the pelvis or thigh. If hemorrhage into the chest or abdomen is suspected, early transport to definitive care with fluid resuscitation is important.