ETATSA Module 4 Coma and Convulsions 2013 Emergency

ETAT-SA Module 4 Coma and Convulsions 2013

Emergency Triage Signs A B C D (severe) Airway Breathing Circulation Coma Convulsion Dehydration

Objectives • Assess consciousness using the AVPU score • Identify the child in coma • Identify the child having convulsions • Treat the child with coma and convulsions

HOW DO WE ASSESS THE CHILD FOR COMA AND CONVULSION?

Is the child in coma?

Consciousness assessment- the AVPU Score • • A V P U Is the child Alert? Is the child responding to Voice? Is the child responding only to Pain? The child who is Unresponsive to voice (or being shaken) AND to pain is – Unconscious

What is COMA using the AVPU Score? P and U in AVPU = Coma

Is the child convulsing now?

Is the child convulsing now? • Sudden loss of consciousness + • Uncontrolled jerky movements of the limbs and/or face • Stiffening of the arms and legs • Uncontrolled movements of the arms and legs • Twitching of the face, hands or feet • Abnormal movements of the eyes • Brief apnoeas

Treatment of coma and convulsions

Treatment of coma Airway and Breathing • manage the airway – Position the child and protect the cervical spine if trauma is suspected – Suction gently and jaw thrust – Give oxygen via face mask • Check the blood glucose – Give IV glucose

Airway: Infant – neutral position

Airway: Sniffing position- older child

Jaw thrust

Recovery position

Check Dextrostix DON’T EVER FORGET GLUCOSE !!

What is Low Sugar?

Low blood glucose = Hypoglycaemia < 3 mmol/l

How do we manage low Sugar?

GIVE IV GLUCOSE 5 ml/kg of 10% glucose solution

Give Glucose (Chart 9) Insert IV line and draw blood rapidly for emergency laboratory investigations Check blood glucose. If low <3 mmol/litre (55 mg/dl) or if dextrostix is not available: Give 5 ml/kg of 10% glucose solution rapidly by IV injection

How to manage coma and convulsions

How to manage convulsions

How to manage convulsions

Treatment of convulsions • Manage the Airway and Breathing Position the child Suction gently Do not place anything into the mouth! Give oxygen via face mask • Check the blood glucose • Give IV glucose • Stop the seizure • Give anticonvulsant

STOP THE SEIZURE Give anticonvulsant

Coma and Convulsions Complications • Status epilepticus-seizure lasts for > 30 minutes • Brain swelling • Brain damage after cell death • Choking and aspiration of vomitus • Death

Stop the seizure

Give Anticonvulsant

Stop Convulsions Part 1

Stop Convulsions Part 1

IV Phenobarbitone available

Stop Convulsions Part 2

No IV Phenobarbiton e available

Stop Convulsions Part 2

What about NEONATES? Phenobarbitone is the drug for neonates (infants < 4 weeks of age) to control convulsions.

What to do after the fit has stopped? • • • Recheck A-B-C Monitor further seizures Treat for infection Recheck blood glucose Provide after-care

SUMMARY

VIDEO: Coma Convulsions and Taken from ETAT DRAFT CLIPS July 2007 Sequences 9, 10, 11.

Demo: Give anticonvulsant.