PAEDIATRIC ALTERED CONSCIOUS LEVEL GUIDELINE
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DELPHI PROCESS

Round two

8. Shock

8f) (iii) If more than 40 ml per kg has been given, intubation and ventilation should be considered to prevent uncontrolled pulmonary oedema developing

Position	Comment
Neuro	Would need data from saturation, clinical exam and blood gases
PICU	CONSIDERED ONLY AS MANY CHILDREN WILL NOT REQUIRE INTUBATION
Renal	Emphasis on considered

Agreed	Neither agree nor disagree	Disagreed
78%	17%	5%

8f) (iv) If more than 40 ml per kg has been given with little clinical response, drug treatment to support the circulation should be considered.

Position	Comment
ED	Comments: find the cause, if not trauma, then possibly.
Neuro	Depending upon the working diagnosis
Renal	Again emphasis on considered - more fluid may be the solution`
Paed ED	but further fluid bolus could be given
Paed	I think this should be even more strongly worded

Agreed	Neither agree nor disagree	Disagreed
88%	8%	4%

8g) Children with a reduced conscious level and shock which has been unresponsive to 40 ml per kg should be monitored on an intensive care or high dependency unit.

Position	Comment
Paed	These children should be discussed with a PICU at the very least if in a DGH
PICU	Key = nursing ratio 1:2 patients + obs to be done and interval initially TPR GCS every 15 mins

Agreed	Neither agree nor disagree	Disagreed
100%