Pediatrics 24 / 2 /2018 Designed by: Dr. Esraa Alnabilsy

1. By: Dr. Esraa Alnabilsy

2. • Introduction.
• Etiology.
• Physical Evaluation.
• Laboratory Evaluation.
• Management & Treatment.
• Prognosis & Coma Sequels.

4. Lethargy ( ): Sleepiness & lack of energy.
‫الذهول‬/ Stupor :‫اإلحساس‬ ‫تبلد‬Obtundation:
‫النعاس‬ ‫أو‬ ‫الفتور‬

8.  Stabilize the patient ( Later in Management ).
 Proper detailed History ( to determine the cause ).
 Physical Examination:
- Assessment of coma.
- Neurological examination.
- Assessment of all body systems.
 Laboratory & Imaging Studies ( Later ).

11. Eye Opening
Verbal Response
Motor Response
(‫يئن‬)

13. The GCS is obtained by adding
the value for each category
minimal = 3 / maximum = 15

14. presence of abnormal posturing indicates a severe medical emergency requiring immediate medical attention

15. The pupillary light reflex (PLR)

17. • Verbal or Motor Response.
• Eye Opening / Fixation.
• Motor Response / Posturing.
Worsening of these signs
may indicate increased
intra cranial pressure ( ICP )
• Papillary Light Reflex.
• Oculocephalic Reflex.
Abnormalities indicate
brainstem injury

18. Laboratory evaluation of coma:
• Blood counts leukocytosis.
• Blood culture if infection is suspected.
• CSF examination in cases of infections of CNS & meninges.
• Ct scan or brain MRI in cases of head trauma or injury.
• Metabolic screen, blood sugar, blood urea, serum electrolytes.
• Liver function test in cases of hepatic encephalopathy.
• Urinalysis & Slide for malaria parasite.
• EEG especially if there is seizure activity.

19. • The main objective of therapy is
to find the cause & remove it.
• Maintain clear airway ABCs:
Supplement O2.
IV asses.
Blood pressure support as needed.

20. Treat the cause:
 Supportive care: Antipyretics.
 If the cause is hypoglycemia:
give 1-2 ml of 10 % Dextrose water.
 If patient in shock: start rapid infusion of volume
expansion fluids ( blood plasma & normal saline ).
 Control convulsions: by anticonvulsants medications.

21.  Correct Cerebral edema:
by giving IV Mannitol & Dexamethasone.
 If the cause is infections: give antibiotics.
 In case of Ingestion: give Naloxone 0.1 mg / kg.
 In case of increased ICP: give Mannitol 0.5 - 1 gram / kg.

22. Nursing care:
 Position: change every half hour to prevent bedsores.
 Nutrition: adequate nutrition through NG tube.
 Oral hygiene.
 Care of eyes & skin.
 Ventilator care.
 Care of bowel:
to prevent impaction of stools.
 Physiotherapy to prevent
contractures.

23.  The prognosis for a coma varies with each situation.
 The chances of a child recovery depend on the cause
of the coma, whether the problem can be corrected,
& the duration of the coma.
 If the problem can be resolved, the child can often
return to his or her original level of functioning.
 If the brain damage is severe, a child may permanently
disabled or never regain consciousness.

24.  Comas that result from drug poisonings have a high rate of
recovery, if prompt ( ‫وعاجل‬ ‫فوري‬ ) medical attention is received.
 Comas that result from head injuries tend to have a higher
rate of recovery than comas related to lack of oxygen.
 The longer a child is in a coma, the worse the prognosis. Even
so, many patients can wake up after many weeks in a coma.
 Some children will make a full recovery & become completely
unaffected by the coma. However, they may have significant
disabilities.

25. • Persistent vegetative state: where a child is awake but shows
no signs of being aware of their surroundings or themselves.
• Minimally conscious state:
where a child has limited awareness that comes & goes.
• Brain death: coma, apnea, & absent brainstem reflexes. No
chance of recovery, synonymous with death in most countries.

26. Designed by: Dr. Esraa Alnabilsy