Unresponsive Child Flashcards
GCS 15
M =
Abnormal spastic flexion ; decortecate posture 3
Abnormal rigid response; decerbreat posture 2
Epidural hematoma
Bleeding from middle meningeal artery
• In the epidural space Concave space
• Lucid interval
Become normal then suddenly collapse
Subdural hematoma
Subdural hematoma
• Bleeding from bridging veins
• Between Dura and arachnoid space
Cushioned triad
= increase the intracranial pressure by Big legion • Irregular breathing
• Bradycardia
• Hypertension In due to brain herniation to maintain cerebral perfusion pressure cpp
Why hypertension
• CPP = ICP – MAP
• IF ICP increase need to increase MAP to maintain CPP
Mean arterial pressure
High ICP
• Position 20-45o • Hyperventilation
• Mannitol
• 3% NaCl
Hypertonic to lower the pressure by shifting the sodium
Meningitis/ encephalitis
Empirical ceftriaxone and vancomycin +/- acyclovir
• CT brain to role out space occupying lesion
• Lumbar puncture
One Pill Can Kill
One Pill Can Kill
Koren G 1993 - Analyzed medications that could kill a10kg toddler with 1-2 standard doses
Bar-Oz 2004 - Identified 11 groups of medications that can be fatal for a toddler with one tablet or a teaspoon
Hypoglycemia
Asymptomatic role of 15
• Symptomatic adrenergic Neuroglycopenic D10 2-4 cc/kg then D10 infusion
Hypoglycemia
Asymptomatic role of 15
• Symptomatic adrenergic Neuroglycopenic D10 2-4 cc/kg then D10 infusion
Management of coma
• ABCDE • Blood tests for glucose, ABG, electrolytes, ammonia, liver
and renal function, CBC, lactate and tox screen • Give iv glucose
• Neuro assessment (GCS, evidence of increased ICP, focal
disease, hx of seizures)
• Start broad spectrum Antibiotic if concern for infection • For specific toxins give antidote: naloxone, flumazenil,
physostigmine (anticholinergic OD)
• Treat ICP • Head CT • Treat seizure /consider prophylaxis • Cool to normothermia.
• Detailed history.
