PAEDIATRIC ALTERED CONSCIOUS LEVEL GUIDELINE

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CLINICAL QUESTIONS

 

FLOW DIAGRAM

 

Oval: Questions: In children with altered conscious level and raised intracranial pressure, which treatments will reduce morbidity / mortality (and in which sub-groups)? List: intracranial pressure monitoring, mannitol, steroids, phenobarbitone, morphine, thiopentone In children with altered conscious level, hyperglycaemia induction will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, keeping nil by mouth will reduce morbidity / mortality in which sub-groups? In children with altered conscious level and kept nil by mouth, which feeds can be reintroduced safely and when? In children with altered conscious level, bicarbonate will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, dialysis will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, sodium benzoate / phenylacetate will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, arginine will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, carnitine will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, pyridoxine will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, NTBC will reduce morbidity / mortality in which sub-groups? In children with altered conscious level, vitamin cocktail (thiamine / riboflavin / coenzyme Q10 / ubiquinone) will reduce morbidity / mortality in which sub-groups? Click on the part of the diagram to see which clinical questions relate to which part of the draft pathway

 

Rounded Rectangle: Yes – follow APLSDraft pathway to help understand where the clinical questions fit

 

 

 

 

 

 

 

 


perform “rapid”, “delayed” and special tests before starting specific treatments (eg dietary managements)
 
Oval: Rapid history and clinical examination – (certain features will direct patients into management groups) Rounded Rectangle: No

perform “rapid” and “delayed” bedside tests, start some treatment and arrange special tests before changing treatments

(eg encephalitis)
 
 


perform “rapid” bedside and “delayed” bedside tests and initiate treatments while waiting for “delayed” bedside tests to come back before changing treatments

(eg  meningococcaemia)
 

perform “rapid” bedside tests and treat without further tests

(eg DKA)