Last updated on 11 May 2022 at 10:52 AM (Paed07)

Altered level of consciousness in a child
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, meningitis

Uncommon

diabetic ketoacidosis, cerebrovascular accident, cardiac arrhythmias, hypoglycaemia, organ failure (liver, renal, Reyes syndrome)