11.

An infant or child with an altered level of consciousness

Any child with an altered level of consciousness or in coma requires urgent and careful evaluation to establish the cause and to commence appropriate therapy. The airway must be protected and ventilation maintained (A,B,C,D).

Study focus
During your attachment you need to work toward achieving the following: Knowledge Outline the causes of and plan how to investigate i) transient alterations of consciousness ii) coma Describe the management of common childhood epilepsies. Skills Show how to assess level of consciousness using AVPU scale. Show how to provide basic life support (oral airway, rescue breathing, cardiac compression) to a collapsed infant or child. Show how to manage a child who is fitting. Provide basic advice on management and prognosis of febrile seizures. Attitudes Communicate empathetically with child and caregivers. Recognise that this presentation can cause significant stress in the caregivers.

Reading
Causes of coma Textbook: Chapter 5357 Head injuries Meningitis / encephalitis Seizures Toxin ingestion Cerebrovascular accident Major organ failure Metabolic causes Causes of transient alterations of consciousness - Fits, Faints, Funny turns Textbook: Chapter 40 Seizures ( Febrile and epilepsy) Breath holdong attacks Syncope Hyperventilation Cardiac arrythmias Hypoglycaemia Management of febrile seizures Textbook: Chapter 54 Management of epilepsy in childhood Textbook: Chapter 6241

Viewing
1. CPR demonstration Watch the clip 'Basic CPR in infant and child'. It is on the 'Viewing' page for Breathing difficulties. 2. Go to : 'Spotting the sick child' Read key background information, key points in history,key points in examination and view patients stories (Case1) Also see How to assess disability AVPU scale (In 3 minute tool kit)

Critical practice points

AVPU scale, P is equivalent to a Glasgow Coma Scale of 8. Any child who is only responding to pain or is unconscious must have their airway maintained and protected

Clinical assessment
Know how to use the AVPU scale (P corresponds to a Glasgow Coma Scale of 8) (When assessing transient alterations of consciousness be sure to establish in detail events preceding and following the altered consciousness.