Paediatric Emergencies - Altered Consciousness, Epilepsy, Poisoning and Meningitis Flashcards
What can cause altered consciousness?
Almost anything
Head trauma Toxins Infection Metabolic causes Brain tumour Seizure etc
What is important to ask about on history if a child presents with altered consciousness?
Onset - Gradual or Sudden? Previously unwell? Feed Trauma PMH of seizures
How are children with altered consciousness managed?
A-E approach
What parts of the A-E approach are particularly important when assessing a child with altered consciousness?
Breathing pattern can indicate brain injury & smell breath for alcohol, toxins and ketones
C - admission bloods, clotting, lactate, culture and ABG
D - esp. pupils and glucose
E - Medical ID tag, signs of non blanching rash? Jaundice, fontanelles?
If the cause remains unknown after the A-E approach, what would be your next steps?
CT Head
EEG
Lumbar Puncture
Treat for meningitis/encephalitis if history fits
How would Raised Intracranial Pressure present in a child?
Bulging fontanelles Loss of Consciousness Unequal/unreactive pupils Headache and vomit Abnormal resp. pattern Hypertension and bradycardia Muscle flaccidity Papilloedema
What are the contraindications to lumbar puncture in a child?
Reduced consciousness (GCS <13) Septic shock Likely invasive meningococcal disease Signs of RICP Focal neurology Bleeding tendency
What is status epilepticus?
Any seizure lasting > 30 mins
OR
Series of seizures over a >30 min period without regain of consciousness
However for purpose of nice guidelines start treatment at 5 mins
What can cause status epilepticus?
Epilepsy Fever Febrile convulsion Head trauma CNS infection Poisoning Metabolic disturbance
What is done immediately when a child is in status epilepticus?
A-E assessment
High flow O2
Check glucose
What is done after 5 minutes if the status epilepticus doesn’t resolve?
Buccal Midazolam 300 mcg/kilo if <2 month 2.5mg/kg 3-11 months 5mg/kg 1-4 years 7.5mg/kg 5-9 years 10mg/kg 10-17 years
IV lorazepam
100mcg/kg <11 years old
4mg if 12-17years old
What would you do if status epilepticus isn’t resolving after 15 minutes even following treatment?
Call for senior help
IV Lorazepam 2nd dose
What would you do if status epilepticus hasn’t resolved after 25 minutes despite treatment?
Inform ITU
IV Phenytoin infusion - 20mg/kg
What would you do if status epilepticus hasn’t resolved after 45 minutes despite treatment?
Rapid sequence induction of anaesthesia
What investigations must be done following life supporting treatment for status epilepticus?
ABG Calcium Magnesium Clotting Anti-Epileptic drug level EEG Imaging Lumbar Puncture
When do most cases of poisoning occur?
Toddler accidentally ingest something they shouldn’t
What can be other causes of poisoning in children?
Adolescents - self harm
Deliberate poisoning
What must you establish in the history?
Exactly what was ingested - name, brand, concentration
When they ingested it
How much they ingested
What investigations should be done following a child coming in with poisoning?
Urine toxicology screen ABG Carboxyhaemoglobin ECG Abdo X-Ray
What should the examination of a poisoned child include?
Inspection of oropharynx and vomitus
Assess level of consciousness
What possible management options are there for swallowing?
Activated charcoal - 1g/kg within 1 hour of ingestion
Specific treatments for certain drugs and toxins
Gastric lavage
Ipecacuanha
Bowel irrigation
What must be done if the poisoning is due to deliberate self harm?
Admit to hospital for psychiatric assessment
What can Iron overdose cause and how is it treated?
Shock and Gut Haemorrhage
IV Desferrioxamine
What can paracetamol overdose cause and how is it treated?
Liver failure
IV N-Acetylcysteine
