An infant or child with an altered level of consciousness Flashcards Preview

Pediatrics > An infant or child with an altered level of consciousness > Flashcards

Flashcards in An infant or child with an altered level of consciousness Deck (13):
1

Etiology

Acute asphyxial event->birth, cardiac arrest, near miss cot death
Shock
Convulsions
Renal failure
Liver failure
Reye's syndrome
Metabolic->hypoglycemia, diabetic ketoacidosis, inborn errors of metabolism
Raised intracranial pressure
Head injury
Meningitis/encephalitis
CVA->vasculitis, hypertension, thrombotic, malformations

2

Important history

Possible drug?
Prodromal illness? Contact with serious illness
Assess possibility of non-accidental injury
History of convulsions and duration
Was the child neurodevelopmentally normal prior to the onset

3

Examination

Vitals->look for bradyC (+ICP), tachyA (drugs). Deep sighing (kussmaul's). Ketones smelt on breath.
Look for fucus of infection. Check for rashes and neck stiffness, pneumonia and UTI.
Check pupils are symmetrical and do the constrict appropriately to light?
Check for abnormal posturing
Assess LOC w/ AVPU or GCS
Always check blood glucose

4

What is the most common metabolic cause of coma

Hypoglycemia

5

Investigations and their significance (11)

Blood glucose->hyper/hypoG
FBE->infection or acute blood loss
Blood culture
UEC->High urea in deH, sodium may be high or low
Blood gases->metabolic or respiratory acidosis
CXR->infection or cardiac failure, trauma
CT/MRI->Focal pathology: tumor, abscess, hemorrhage
LP->infection or bleeding
Metabolic screen->ammonia + in urea cycle defects and Reye's
LFTs->hepatic encephalopathy
Urine->toxicology screen for poisoning or overdose

6

What does a score of P corresponds to a GCS of... and what does it suggest needs to be done.

Corresponds to a GCS of 8 and the airway needs to be protected to prevent intubation

7

What does coma mean

Pre-comatose state with altered level of consciousness

8

Viral causes of meningitis

Mumps
Coxsackie
Echovirus
Herpes simplex
Poliomyelitis

9

Bacterial causes of meningitis

N, meningitidis
S. pneumoniae
Haemophilus influenzae type B
Group B streptococcus
Escherichia coli and listeria

10

Three situations when a LP is not to be done

When +ICP or chance of
When hemodynamically unstable
When thrombocytopenia/coagulopathy

11

Analysis of CSF in viral/bacterial meningitis- appearance, white cells, protein, glucose

Bacterial: Turbid w/ prganisms, +++PMN, ++protein, low glucose
Viral: Clear, +lymphocytes, N protein N glucose

12

treatment of encephalitis (antiB and antiV)

Aciclovir
Erythromycin
Cefotaxime

13

Presentation of Reye's

May be precipitated followed administration of aspirin during a viral illness in young children
Vomiting and lethargy->inflammatory encephalopathic illness with personality change, irritability, coma with +ICP.
Supportive therapy + ICU Mx of +ICP

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