A 10 yr old boy, unconscious with 2 days h/o fever, comes to pediatric ICU with R.R. 46/min, B.P. 110/ 80 and El V1 M3 on Glasgow coma scale, next step of Mx includes -
Ans. is 'a' i.e., Intubate and ventilate Management of unconscious child o Unconsciousness (coma) is usually graded according to a standard scale so that changes in the level of consciousness can be evaluated accurately. o Glasgow coma scale is commonly used evaluation system. In this scale : ? Total score = Eye opening + motor response + verbal response o The best response is scored. The lowest score is 3, and the highest is 15 (fully conscious child). A score of 8 or less suggests severe brain dysfunction, a score of 9-12 moderate brain dysfunction and a score of 13-15 minor brain dysfunction. Investigations o If the cause of coma is unknown, following investigations may be required : - i) Lumbar puncture ECG iii) Skull radiography/CT/MR' iv) Cervical spine imaging o Blood is drawn for a CBC, electrolyte determination, toxicology tests, blood gas analysis, BUN and cross matching. Management o Care of the child in coma is directed towards maintaining body function in optimal state until the child regains consciousness. Management includes : ? 1) Airway As a general rule, place the child on his/her side to reduce the risk of aspiration. Oral suctioning to remove mucus from the mouth and pharynx may be necessary. If Glassgow score is 8 or less and clinical circumstances do not suggests improvement then intubation is indicated to secure airway. 2) Breathing Oxygen is given especially when oxygen saturation is low. 3) Circulation Venous access is obtained. Signs of shock are assessed and treated as indicated. 4) Drugs and specific therapy After maintenance of breathing and circulation, specific therapy is given e.g., antibiotics for infection, dextrose in hypoglycemia, naloxone in opiates poisoning etc.
Intubate and ventilate
Give 0.9% NaC1
Sta dopamine at the rate of 1-2 g / min / kg
Dopamine at the rate of 1-2 g / min / kg & furosemide