The comatose child
The child who presents with acute coma runs a high risk of cardiopulmonary insufficiency, direct brain injury or even cerebral herniation. The case-management of such child requires a coma-specific emergent evaluation, immediate treatment of any hypoxicischemic insults and of the underlying cause. T...
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| Veröffentlicht in: | Therapeutische Umschau 2005-08, Vol.62 (8), p.519-524 |
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| container_title | Therapeutische Umschau |
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| creator | Wagner, B P |
| description | The child who presents with acute coma runs a high risk of cardiopulmonary insufficiency, direct brain injury or even cerebral herniation. The case-management of such child requires a coma-specific emergent evaluation, immediate treatment of any hypoxicischemic insults and of the underlying cause. The coma-specific examination includes performance of child-adapted Glasgow Coma Score, the evaluation of brain stem functions such as pupillary response to light, cough- and gag reflex, and determination of all vital signs including body temperature. Treatment of hypoxicischemic insults includes control of airways and ventilation in patient with coma defined as GCS |
| format | Article |
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The case-management of such child requires a coma-specific emergent evaluation, immediate treatment of any hypoxicischemic insults and of the underlying cause. The coma-specific examination includes performance of child-adapted Glasgow Coma Score, the evaluation of brain stem functions such as pupillary response to light, cough- and gag reflex, and determination of all vital signs including body temperature. Treatment of hypoxicischemic insults includes control of airways and ventilation in patient with coma defined as GCS <8; liberal treatment of impaired cardiovascular states with isotonic fluids such as 0.9% sodium chloride; and treatment of cerebral herniation with head elevation, mannitol, hypertonic sodium chlorid fluids, steroids and hyperventilation. Immediately treatable causes are hypoglycemia, meningitis/encephalitis, opioid overdose and status epilepticus. Exclusion of rapidly progressive intracranial lesions almost always requires referral to the tertiary centre with head CT-scan facilities. Finally, an extensive etiology search of the stable coma is performed by looking for disease or trauma of the brain, for metabolic causes, for intoxications and for cardiopulmonary problems.</description><identifier>ISSN: 0040-5930</identifier><identifier>PMID: 16136815</identifier><language>ger</language><publisher>Switzerland</publisher><subject>Brain Injuries - complications ; Brain Injuries - diagnosis ; Brain Injuries - therapy ; Child ; Child, Preschool ; Coma - diagnosis ; Coma - etiology ; Coma - therapy ; Critical Care - methods ; Diagnosis, Differential ; Emergencies ; Emergency Medicine - methods ; Emergency Treatment - methods ; Germany ; Humans ; Hypoxia-Ischemia, Brain - complications ; Hypoxia-Ischemia, Brain - diagnosis ; Hypoxia-Ischemia, Brain - therapy ; Infant ; Infant, Newborn ; Practice Guidelines as Topic ; Practice Patterns, Physicians</subject><ispartof>Therapeutische Umschau, 2005-08, Vol.62 (8), p.519-524</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16136815$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wagner, B P</creatorcontrib><title>The comatose child</title><title>Therapeutische Umschau</title><addtitle>Ther Umsch</addtitle><description>The child who presents with acute coma runs a high risk of cardiopulmonary insufficiency, direct brain injury or even cerebral herniation. The case-management of such child requires a coma-specific emergent evaluation, immediate treatment of any hypoxicischemic insults and of the underlying cause. The coma-specific examination includes performance of child-adapted Glasgow Coma Score, the evaluation of brain stem functions such as pupillary response to light, cough- and gag reflex, and determination of all vital signs including body temperature. Treatment of hypoxicischemic insults includes control of airways and ventilation in patient with coma defined as GCS <8; liberal treatment of impaired cardiovascular states with isotonic fluids such as 0.9% sodium chloride; and treatment of cerebral herniation with head elevation, mannitol, hypertonic sodium chlorid fluids, steroids and hyperventilation. Immediately treatable causes are hypoglycemia, meningitis/encephalitis, opioid overdose and status epilepticus. Exclusion of rapidly progressive intracranial lesions almost always requires referral to the tertiary centre with head CT-scan facilities. Finally, an extensive etiology search of the stable coma is performed by looking for disease or trauma of the brain, for metabolic causes, for intoxications and for cardiopulmonary problems.</description><subject>Brain Injuries - complications</subject><subject>Brain Injuries - diagnosis</subject><subject>Brain Injuries - therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Coma - diagnosis</subject><subject>Coma - etiology</subject><subject>Coma - therapy</subject><subject>Critical Care - methods</subject><subject>Diagnosis, Differential</subject><subject>Emergencies</subject><subject>Emergency Medicine - methods</subject><subject>Emergency Treatment - methods</subject><subject>Germany</subject><subject>Humans</subject><subject>Hypoxia-Ischemia, Brain - complications</subject><subject>Hypoxia-Ischemia, Brain - diagnosis</subject><subject>Hypoxia-Ischemia, Brain - therapy</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians</subject><issn>0040-5930</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1jz1rw0AQRK9wiB07TX5ASJVOsKvbPd-VweTDYHCjXpxOe1hBshSdVeTfRyFONTPweDALtQIgyNhpWKq7lD7nycTmVi3RoDYWeaUeipM8hb7zlz7N5dS09UbdRN8mub_mWhVvr8XuIzsc3_e7l0M2zJZMwFDgvIqk68AkW2sEMAAF9A4heGAdt1EHlyO6ymtgrLyNHF3MLWm9Vs9_2mHsvyZJl7JrUpC29Wfpp1Qay0Rkf8HHKzhVndTlMDadH7_L_xP6B_ciP1Q</recordid><startdate>200508</startdate><enddate>200508</enddate><creator>Wagner, B P</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>200508</creationdate><title>The comatose child</title><author>Wagner, B P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p545-e064c52bf43dc54e786e01c04c1a910ca053f7f3c92119ba3051ba8f5f9f28433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>ger</language><creationdate>2005</creationdate><topic>Brain Injuries - complications</topic><topic>Brain Injuries - diagnosis</topic><topic>Brain Injuries - therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Coma - diagnosis</topic><topic>Coma - etiology</topic><topic>Coma - therapy</topic><topic>Critical Care - methods</topic><topic>Diagnosis, Differential</topic><topic>Emergencies</topic><topic>Emergency Medicine - methods</topic><topic>Emergency Treatment - methods</topic><topic>Germany</topic><topic>Humans</topic><topic>Hypoxia-Ischemia, Brain - complications</topic><topic>Hypoxia-Ischemia, Brain - diagnosis</topic><topic>Hypoxia-Ischemia, Brain - therapy</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wagner, B P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Therapeutische Umschau</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wagner, B P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The comatose child</atitle><jtitle>Therapeutische Umschau</jtitle><addtitle>Ther Umsch</addtitle><date>2005-08</date><risdate>2005</risdate><volume>62</volume><issue>8</issue><spage>519</spage><epage>524</epage><pages>519-524</pages><issn>0040-5930</issn><abstract>The child who presents with acute coma runs a high risk of cardiopulmonary insufficiency, direct brain injury or even cerebral herniation. The case-management of such child requires a coma-specific emergent evaluation, immediate treatment of any hypoxicischemic insults and of the underlying cause. The coma-specific examination includes performance of child-adapted Glasgow Coma Score, the evaluation of brain stem functions such as pupillary response to light, cough- and gag reflex, and determination of all vital signs including body temperature. Treatment of hypoxicischemic insults includes control of airways and ventilation in patient with coma defined as GCS <8; liberal treatment of impaired cardiovascular states with isotonic fluids such as 0.9% sodium chloride; and treatment of cerebral herniation with head elevation, mannitol, hypertonic sodium chlorid fluids, steroids and hyperventilation. Immediately treatable causes are hypoglycemia, meningitis/encephalitis, opioid overdose and status epilepticus. 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| ispartof | Therapeutische Umschau, 2005-08, Vol.62 (8), p.519-524 |
| issn | 0040-5930 |
| language | ger |
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| source | Hogrefe eContent; MEDLINE |
| subjects | Brain Injuries - complications Brain Injuries - diagnosis Brain Injuries - therapy Child Child, Preschool Coma - diagnosis Coma - etiology Coma - therapy Critical Care - methods Diagnosis, Differential Emergencies Emergency Medicine - methods Emergency Treatment - methods Germany Humans Hypoxia-Ischemia, Brain - complications Hypoxia-Ischemia, Brain - diagnosis Hypoxia-Ischemia, Brain - therapy Infant Infant, Newborn Practice Guidelines as Topic Practice Patterns, Physicians |
| title | The comatose child |
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