|
PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round one
16. No clinical clues to cause
Statement 16a
(i) A child with a reduced conscious level and no obvious
clinical signs pointing towards the cause should have the core investigations
and further tests sent (“core investigations performed” will be defined as the
investigations agreed upon in Statement 7d; “further tests” will be defined as
the investigations agreed upon in statements 7e)
|
%
Agree |
%
Disagree |
Result |
|
96.9% |
0% |
Included |
|
Position |
Comments |
|
ED |
easier to answer when “core investigations” agreed |
(ii) A child with a reduced consciousness and no obvious clinical signs pointing towards the cause should have supportive treatments implemented to protect their airway, breathing and circulation
|
%
Agree |
%
Disagree |
Result |
|
96.9% |
0% |
Included |
|
Position |
Comments |
|
PICU |
depends on clinical exam/assess |
(iii) A child with a reduced consciousness and no obvious clinical signs pointing towards the cause should be started on broad spectrum antibiotics
|
%
Agree |
%
Disagree |
Result |
|
90.9% |
6.1% |
Included |
|
Position |
Comments |
|
Metab |
Have cultures been taken? |
|
PICU N |
with other signs of infection |
|
Neuro |
After b/c etc |
|
PICU |
in presence probable sepsis |
(iv) A child with a reduced consciousness and no obvious clinical signs pointing towards the cause should be started on aciclovir
|
%
Agree |
%
Disagree |
Result |
|
81.8% |
6.1% |
Included |
|
Position |
Comments |
|
PICU |
not always. need to Ix… |
|
Metab |
Have appropriate investigations been sent? |
(v) A child with a reduced consciousness and no obvious clinical signs pointing towards the cause should be treated for non-convulsive status epilepticus if an urgent EEG is not obtainable
|
% Agree |
%
Disagree |
Result |
|
34.6% |
26.9% |
Excluded |
|
Position |
Comments |
|
Neuro |
There are often clues one way or the other. Treatmrent of non-convulsive SE is not an emergency; treatment can be dangerous. Nearly always better to wait |
|
Neuro |
Reasonable if clinical signs e.g. nystagmus, slight twitching of a limb but care needed as treatment with benzodiazepines in unventilated may be dangerous |
Statement 16b
If there is no obvious cause for the child’s reduced conscious level discuss the case with a paediatric neurologist within 6 hours of admission
|
%
Agree |
%
Disagree |
Result |
|
78.1% |
3.1% |
Included |
|
Position |
Comments |
|
Neuro |
6 hours may be too long. I would like to know after 2-3 hours, unless GCS was improving |
|
Paed |
Not sure about 6 hours |
|
Endo |
Not sure if this is practical in most settings |
|
Paed |
sooner |