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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.
Progress Test-Type Questions: Question 1 | Question 2Applied 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)
- 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
- 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
- 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
- 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
- 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
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
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)
diabetic ketoacidosis, cerebrovascular accident, cardiac arrhythmias, hypoglycaemia, organ failure (liver, renal, Reyes syndrome)
