Version May 2024
| Evaluation |
| Vital signs and general and trauma examination |
| Neurologic examination and GCS |
| Fingerstick blood glucose Blood gas (arterial or venous) Screening laboratories (CBC, glucose, electrolytes, BUN, creatinine, blood and urine cultures, LFTs, urinalysis, urine drug screen) |
| Head CT scan: do urgently if focal neurologic signs, papilledema, or fever; consider rapid MRI instead if available |
| Lumbar puncture: do urgently after CT scan if fever, elevated WBC, meningismus; otherwise do according to level of suspicion for diagnosis or if cause remains obscure |
| Other laboratory tests: for metabolic conditions*, coagulation tests, carboxyhemoglobin, specific drug concentrations; do according to level of suspicion for diagnosis or if cause remains obscure |
| EEG: for possible nonconvulsive seizure, or if diagnosis remains obscure |
| Brain MRI with DWI, if cause remains obscure |
| Management |
| ABCs: |
| Intubate if GCS ≤8 or respiratory failure |
| Stabilize cervical spine |
| Supplement O2 |
| IV access |
| Blood pressure support as needed |
| Treat hypoglycemia identified on fingerstick. Dextrose 0.25 g/kg (2.5 mL/kg of 10% dextrose solution) after blood glucose drawn, before results back; do NOT delay pending results. |
| Treat definite seizures. Initial treatment with lorazepam (0.1 mg/kg, maximum single dose 4 mg). If seizures continue treat as for status epilepticus. |
| Empiric treatments: |
| For suspected infection: |
| Ceftriaxone 100 mg/kg (maximum single dose 2 grams) and vancomycin (age-specific dose) |
| Acyclovir (age-specific dose) |
| For suspected ingestion: |
| Naloxone 0.1 mg/kg IV in patients up to 20 kg or ≤5 years; maximum 2 mg IV (use if opioid toxidrome: miosis, respiratory depression, hypotonia) |
| For suspected increased ICP: |
| Mannitol 0.5 to 1 g/kg IV; or Hypertonic saline 3% 5 mL/kg Also, elevate head and keep midline |
| For suspected nonconvulsive status epilepticus: |
| Lorazepam (0.1 mg/kg, maximum single dose 4 mg). If suspicion of seizures continues, treat as for status epilepticus. |
| Fosphenytoin (10 to 20 PE equivalents/kg). If suspicion of seizures continues, treat as for status epilepticus. |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
