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Flashcards in Coma Deck (8):

Immediate management

Attend to ABC Trauma possible->immobilise the spine Arrange urgent neurosurgical consult Insert IV Perform blood glucose (manage if hyper/hypo) Consider naloxone (0.1mg/kg IV) Assess and monitor pulse, RR, BP, temperature, oximetry ECG Look for signs of convulsion


Important past history considerations

Seizures Diabetes Adrenal insufficiency Infection Cardiac Previous similar episodes


Examination findings to look for and their considerations

Scalp bruising/hemtatoma->Head injury Inconsistent history, retinal hemorrhage->NAI Fever, seizures->Meningitis, encephalitis Focal neurological, focal seizures, papilloedema, asymmetric pupils->Focal IC pathology Shunted hydrocephalus->Blocked shunt Renal disease->Hypertensive encephalopathy


Investigations to consider

full blood examination urea and electrolytes glucose liver function test arterial blood gas urine drug ± metabolic screen urine antigens culture of blood and urine ammonia cortisol coagulation screen ECG


Requirements to meet prior to doing LP

No papilloedema No focal neurology or focal seizure Not immediately after a seizure Rousable to full consciousness If not rousable-> >2 with definite neck stiffness and no localising signs


Management if Papilloedema or focal neurological/focal seizure

Febrile->give aciclovir + cefotaxime. Consider MRI/CT. No LP Not febrile->MRI/CT; consider aciclovir and cefotaxime if results unclear a to whether infection


Management when no +pap, no focal, immediately after seizure

Give paracetamol 20mg/kg once if febrile and consider antibiotics if no improvement in conscious state or recovery X w/i 6 hours


Coma flow chart->LP, imaging and antibiotics

Flow chart

Decks in Pediatrics Class (58):