I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Friday, 14 February 2014

Reduced Consciousness in Children

The unconscious child has some specific causes which we have looked at in more detail. There are also some more general causes, covered thoroughly on enlightenme. There are some specific guidelines from Nottingham that are universally accepted.

- Clues to dehydration
- Consanguinous relationship should be sought.

Specific Examination
- The child should be examined to look for physical clues which may suggest an underlying metabolic problem, such as dysmorphism, hypotonia, failure to thrive and enlarged liver.
- Look for herpetic lesions
- Paediatric GCS

- Blood gas: pH, pCO2, bicarbonate and lactate may provide useful information in cases of shock, sepsis, trauma, respiratory distress, or suspected acid-base imbalance.
- If sepsis suspected: urinalysis, full blood count: haemoglobin, white cell count and differential, and platelet count; blood culture (meningococcal pcr depending on clinical presentation), CRP.
- Metabolic-specific cases: Venous/arterial blood gas, glucose, urinary ketones, LFTs, serum ammonia, U+Es (consider if BM <2.6mmol/L)
- Overdose cases: Plasma, serum and urine to be saved for later analysis of specific agents e.g. opiates, tricyclics

Consider trial of naloxone

High ammonia levels (>200micromol/L) are neurotoxic. Lower levels with a sodium benzoate infusion.

If meningitis is suspected, treating with steroids (dexamethasone 0.15 mg/kg prior to first dose of antibiotics) reduces profound hearing loss if the causative agent is Haemophilus influenza type B (HIB) and less so in cases of meningococcal or streptococcal infection.

Herpes simplex encephalitis should be suspected in a child with a decreased consciousness and focal neurological signs, fluctuating consciousness, contact with herpetic lesions.

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