A child presented in the casuality with fever, unconcous & papilloedema. What next to the done ?
Ans. is 'a' i.e., lntubation; `b' i.e., Oxygenation; 'c' i.e., CT Scan o The child in question with fever, unconsciousness & papilloedema, probably suffering from complicated meningitis/ encephalitis. Papilloedema is uncommon in uncomplicated meningitis & should suggest a more chronic process, such as the presence of an intracranial abscess, subdural empyema or occlusion of a dural venous sinus. Emergency & critical care management of a comatose child with intracranial hypeension : The main goals of care include optimizing cerebral blood flow, cerebral perfusion pressure & minimizing factors that can aggravate neurological injury or trigger intracranial pressure elevation. General measures are : 1) Assess the Airway, Breathing & Circulation (ABC) -* Intubation, oxygen etc. 2) Assess & treat for immediately correctable causes of coma, like hypoglycemia, dyselectrolytemia etc. 3) Assess the depth of coma with Glassgow coma scale. 4) Assess & treatment of raised intracranial pressure with Mannitol, Hypeonic saline solutions. 5) Antiseizure medications. Neuroimaging : A CT scan may provide information about the cause of altered mental status & the presence of intracranial hypeension, however a normal CT scan does not rule out raised ICP. MRI is also helpful for early changes. 7) Lumber puncture helpful for diagnosis & treatment of CNS infective causes. In an unconscious child with potential raised ICP, the decision is controversial with some authors stating that the risks of herniation for outweighs the benefit of knowing the pathogen from an early lumber puncture. 8) Choice of empiric broad-spectrum antibiotic, till confirmatory tests available. 9) Dextrose containing hypotonic IVF should be avoided & enteral feed staed at the earliest. 10) Others like steroids, Barbiturates etc.
Intubation
Oxygenation
CT scan
All