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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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COMMENTS
Please comment
on any aspect of the guideline whilst it is being developed by emailing Richard
Bowker at richard.bowker@nottingham.ac.uk,
and your comments will appear (anonymously unless specified) on the comments
board with responses from the Guideline Development Group and other viewers of
this site posted on the RESPONSES board.
Comments on this board are NOT guideline
recommendations.
Any suggestions on this comments board are there for
discussion purposes only.
COMMENTS BOARD
Comment regarding transfer for dialysis Based on recent experience [in]
a tertiary service : 1. Commence medical therapy to
reduce ammonia immediately (at referring hospital) 2. Transfer should be the
immediate priority to that centre which has the necessary metabolic
expertise + dialysis. Do NOT wait to decide on next sample. Transfer. 3. Inform paediatric nephrology
service - to prepare necessary equipment, staff etc 4. Patient should be received
into high dependency but preferably, intensive care unit 5. A repeat sample should be
arranged within an agreed time after commencement of medical therapy to
determine efficacy - but patient should already be in transit to tertiary
centre. 6. Dialysis can be commenced
without delay if results show failing conservative/medical therapy We provide a technical service
and can haemodialyse babies <1kg. The highly specialised equipment takes
some time to set up. Regional geography dictates the immediate transfer as
a critical time saving step. The patient may not need our service and
conservative management may work locally, but there is no way of predicting
the latter and surely it is better to be ready to treat(dialyse)
immediately rather than too late. Date received
Preliminary
response available Full response not yet available Comment regarding TB meningitis Looking through this guideline
i was unclear as to what stage you would consider the diagnosis of TB
meningitis ? What additional features you
would look for (other than the obvious CSF findings). When would the group recommend
doing a TB PCR on CSF etc. Date received
23/06/2004 Preliminary
response available Full response not yet available