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Altered level of consciousness in a child

Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Nervous System, Neurology, Paediatrics
Progress Test Topic(s)
Neurological
Description
A 3 year old Samoan girl is brought by ambulance to Emergency Department. She is breathing by herself, groaning and only responding to pain. Her mother says she has had a 'fit' at home.
Applied Science for Medicine 
   - Anatomy and physiology of the brain
   - Epilepsy syndromes
   - Microbiology of meningitis and encephalitis
   - Pharmacology of anticonvulsants: benzodiazepines/midazolam, lorazepam for status epilepticus, phenytoin, phenobarbitone; route of medication delivery in emergency/status epilepticus (e.g: intranasal, buccal and rectal)
Clinical and Communication Skills 
   - Elicit a history
   - Assessment of level of consciousness using paediatric AVPU (Alert, Voice, Pain, Unresponsive) scale
   - Provision of basic life support (oral airway, rescue breathing, cardiac compression) to a collapsed infant or child
   - Causes and investigation of alterations of consciousness and coma (physical examination for meningitis, raised intracranial pressure)
   - Management of status epilepticus and/or fitting child
   - Understand common childhood epilepsies and febrile convulsions
   - Give basic advice on management and prognosis of febrile seizures
   - Measurement and interpretation of blood glucose, electrolytes and blood gas
   - Appropriate engagement and consultation with family/whānau, as well as the patient
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Communicate with the patient and family/whānau in a way that ensures they have sufficient knowledge and understanding to be able to make informed decisions and give informed consent
   - Delivery of difficult questions regarding child safety and abuse
   - Recognise that this presentation can cause significant stress in the caregivers
Hauora Māori 
   - Assess health literacy needs of whānau
   - Consideration of access to cultural/spiritual support for whānau
   - Competency in engaging in a family/whānau meeting if required
Population Health 
   - Vaccination to prevent meningitis and encephalitis (Hib, pneumococcal, meningococcal, measles)
   - Accident prevention/screening for safety in the home including domestic violence
Conditions to be considered relating to this scenario
Common
febrile convulsion, seizure disorder and/or status epilepticus, meningitis, other infection leading to septic collapse and/or seizure, head injury, breath holding attacks
Less common but 'important not to miss'
raised intracranial pressure, subdural tumour, metabolic disorders, non accidental injury/head trauma, drug induced- accidental ingestion, encephalitis
Uncommon
diabetic ketoacidosis, cerebrovascular accident, cardiac arrhythmias, hypoglycaemia, organ failure (liver, renal, Reyes syndrome)
Related Scenarios
[Epilepsy / seizure]