Unconscious child

Question 1

Causes of benign syncope

Answer 1

Vasovagal
Cardiogenic
Orthostatic (postural hypotension)
Breath holding spell (BHS)

Question 2

Vasovagal syncope causes

Answer 2

Psychogenic (fear, emotion, etc) 
Micturition syncope
Cough syncope 
Carotid sinus syncope - turning neck, tight collar, etc
Post-exercise

Question 3

Causes of cardiogenic syncope

Answer 3

Decreased BP - if only transient; 
Aortic stenosis
Congenital heart defect 
Arrythmias 
Myocarditis 
CAD 
Pulmonary hypertension

Question 4

Causes of coma

Answer 4

Toxins
Infections
Head trauma 
Hypoxia-ischemia 
Seizures
Systemic diseases 
Metabolic disorders

Question 5

Definitions

Answer 5

Consciousness
Syncope, pre-syncope
Coma

Question 6

Clinical features of syncope

Answer 6

Pale appearance
Prodrome: 
- dizziness
- lightheadedness
- nausea
- sweating
- visual changes (blacking out) 
- palpitations possible

Question 7

Signs of raised ICP

Answer 7

Papilledema

Question 8

Management of unconscious patient

Answer 8

ABCDE, GCS assessment

Question 9

Coma ddx

Answer 9

ABCDE, adjunctive tests - labs, tox screen, head CT, brain MRI, EEG, etc
History and physical exam important - signs of trauma, etc.
Specific breathing patterns: Cheyne Stokes, Hyperventilation, etc….

Question 10

Causes of unconsciousness

Answer 10

Syncope
See causes of coma - can be unconsciousness where patient becomes responsive again (e.g concussion), or patient goes into coma

Question 11

Benign syncope management

Answer 11

Most cases are vasovagal - reassurance to patient, family
History and physical exam important - could be more sinister underlying cause
If recurrent / impacting daily life - definitely consider underlying causes