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Editor's Notes
- #3 THM 1: Wake Kids to Assess
- #4 THM 2: Protect the Unconscious Child
- #5 THM 3: Think 5M
- #6 THM 1: Wake Kids to Assess Unpopular: ED attendance patterns (most stretch beyond bedtime) Tricky: though parents often have ways! Essential!
- #7 Video of trying to wake child
- #8 Video of trying to wake child
- #9 Beware the child who is “lethargic” or “just not right” Conscious level is hard for non-clinicians to quantify Trust parental instinct
- #10 ASSESS GCS/AVPU – GCS for serial assessment, use paediatric adaptation HR, RR, SpO2, BP, Temp – every hour BM within fifteen minutes
- #11 ASSESS Features, chronology of symptoms Fever, vomiting, headache Fluctuant GCS Trauma Access to meds/history of drug/alcohol use Family history of sudden deaths
- #12 ASSESS Glucose, gas, ketones FBC, U&E with Ca2+, culture Urine LFTs Ammonia
- #13 THM 2: Protect the Unconscious Child Protect airway and breathing Airway obstruction Breathing inadequate (hypoventilation) THM 2: Protect the Unconscious Child – until you know what’s going on, prevent secondary brain injury Optimise CSF outflow: 20-30deg head up No neck lines Normotension, normoxia, normocapnoea, normoglycaemia
- #14 THM 3: Think 5M
- #15 TREAT IT Don’t wait for LP, cef and aciclovir Consider dex if thinking bacterial meningitis
- #16 TREAT IT Don’t wait for LP, cef and aciclovir Consider dex if thinking bacterial meningitis
- #17 Present at two different time points: neonates (more likely absence/complete blockage of metabolic pathway) and later in life, often precipitated out by intercurrent illness (in which case usually partial/incomplete blockage of metabolic pathway) MEASURE IT Ammonia >200mcmol/L – treat with sodium benzoate 250mg/kg in 15ml/kg 10% dextrose over 90mins – metabolic centre Glucose <2.6mmol/L – hypoglycaemia screen, correct with 2ml/kg 10% dextrose. HYPOGLYCAEMIA is NOT A DIAGNOSIS – contact metabolic centre Ketones – nonketotic hypoglycaemia is signifiicant for metabolic disease SWITCH IT OFF: NBM, dextrose,
- #18 Present at two different time points: neonates (more likely absence/complete blockage of metabolic pathway) and later in life, often precipitated out by intercurrent illness (in which case usually partial/incomplete blockage of metabolic pathway) MEASURE IT Ammonia >200mcmol/L – treat with sodium benzoate 250mg/kg in 15ml/kg 10% dextrose over 90mins – metabolic centre Glucose <2.6mmol/L (40mg/dL)– hypoglycaemia screen, correct with 2ml/kg 10% dextrose. HYPOGLYCAEMIA is NOT A DIAGNOSIS – contact metabolic centre Ketones – nonketotic hypoglycaemia is signifiicant for metabolic disease SWITCH IT OFF: NBM, dextrose,
- #19 SCAN IT ICP – mass effect (Beware hypertension/bradycardia) Bleed? Trauma? Tumour?
- #20 SCAN IT ICP – mass effect (Beware hypertension/bradycardia) Bleed? Trauma? Tumour?
- #21 CONSIDER IT Teenagers – drug use? Beware “just alcohol” but value of tox screen in ED limited One pill kills Oral hypoglycaemics, opioids, TCAs, beta blockers, calcium channel blockers, antimalarials, antiarrhythmics, theophylline, salicylates.
- #22 CONSIDER IT Teenagers – drug use? Beware “just alcohol” but value of tox screen in ED limited One pill kills Oral hypoglycaemics, opioids, TCAs, beta blockers, calcium channel blockers, antimalarials, antiarrhythmics, theophylline, salicylates.
- #23 STOP IT Usually obvious May coexist with other pathology Non-convulsile status difficult to identify: consider if increased HR, agitation, sweating etc – bedside EEG helps.
- #24 STOP IT Usually obvious May coexist with other pathology Non-convulsile status difficult to identify: consider if increased HR, agitation, sweating etc – bedside EEG helps.
- #25 ANALGESE IT Diagnosis of exclusion BUT simple enough to give analgesia Acute confusional migraine esp in teenage girls
- #26 ANALGESE IT Diagnosis of exclusion BUT simple enough to give analgesia Acute confusional migraine esp in teenage girls
- #27 THM 1: Wake Kids to Assess Focused history, regular vital sign monitoring and blood tests
- #28 THM 2: Protect the Unconscious Child
- #29 THM 3: Think 5M
- #30 THM 3: Think 5M
- #31 THM 3: Think 5M
- #32 THM 3: Think 5M
- #33 THM 3: Think 5M
- #34 THM 3: Think 5M
- #35 THM 3: Think 5M