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Paeds Casesacute-care-resuscitation-and-toxicology

Paeds Cases · acute-care-resuscitation-and-toxicology

Check the glucose, measure the brain — altered conscious state in children

A bedside structured clinical encounter testing recognition of a child with an altered conscious state, securing the airway, screening with AVPU and converting to an age-adapted Glasgow Coma Scale, checking and correcting the bedside glucose immediately, treating an ongoing convulsion at five minutes, recognising raised intracranial pressure, communication, early escalation, safeguarding in parallel, handover and disposition.

structured clinical encounter (resuscitation leadership)4 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A three-year-old child is brought to the acute assessment area drowsy after a febrile illness, responding to voice only, with a purpuric rash, and then begins to convulse.

Station status

This is one MedVellum formative structured clinical encounter. The scoring, prompts and performance descriptions are educational feedback tools. They are not an official college station, timing, mark allocation, pass score or reproduced examination format. The encounter assesses first-impression recognition, leadership of resuscitation, securing the airway, screening with AVPU and converting to an age-adapted Glasgow Coma Scale, the bedside glucose and DEFG, treating an ongoing convulsion at five minutes, recognising raised intracranial pressure, communication, reassessment, escalation and safe transfer of information. [1] [2]

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References6ShowHide
  1. [1]Hoffmann F, Schmalhofer M, Lehner M, et al. Comparison of the AVPU Scale and the Pediatric GCS in Prehospital Setting Prehospital emergency care, 2016.PMID 26954262
  2. [2]Kirschen MP, Snyder M, Smith K, et al. Inter-Rater Reliability Between Critical Care Nurses Performing a Pediatric Modification to the Glasgow Coma Scale Pediatric critical care medicine, 2019.PMID 30946292
  3. [4]Faustino EV, Hirshberg EL, Bogue CW Hypoglycemia in critically ill children Journal of diabetes science and technology, 2012.PMID 22401322
  4. [6]Chamberlain JM, Kapur J, Shinnar S, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial Lancet (London, England), 2020.PMID 32203691
  5. [9]Dunger DB, Edge JA Predicting cerebral edema during diabetic ketoacidosis The New England journal of medicine, 2001.PMID 11172161
  6. [10]Chávez-Bueno S, McCracken GH Jr Bacterial meningitis in children Pediatric clinics of North America, 2005.PMID 15925663
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