COMA IN CHILD
Overview of Coma
• Coma: An unarousable state of unconsciousness
• Stupor refers to lesser degree of unarousability in which the patient can be awakened only
by vigorous stimuli, accompanied by motor behaviour that leads to avoidance of
uncomfortable or aggravating stimuli.
Causes of Coma IN CHILD
• Infection
o Bacterial
Meningitis
Typhoid fever
Septicaemia
o Viral
Encephalitis
o Protozoa
Severe malaria
• Metabolic
o Hypoglycaemia
o Diabetic ketoacidosis
• Trauma
o Head injury
• Poisons and drugs
• Epilepsy
• Hyperthermia
• Hypothermia.
Assessment and Management of an Unconscious Child
Quick Assessment
• Airway- keep airway clear
• Breathing- make sure that the child is breathing
• Circulation- check pulse and blood pressure
• Position- put child in recovery position.
Glasgow Scale
Glasgow Assessment of the Level of Consciousness (AVPU)
Level of Consciousness Score
A= Alert 0
V= Response to Voice 1
P= Response to Pain 2
U= Unresponsive to any Stimuli 3
Note: 0 is the most responsive score and 3 is the least responsive.
Blantyre Coma Scale
• Another scale which is a modification of Glasgow coma scale
• The score assigned by the Blantyre is a number from 0 to 5
• The result is obtained by adding the results from 3 groups which include:
o Motor response
2= Localizes painful stimuli
1= Withdraws from painful stimuli
0= No response
o Verbal response
2= The child cries appropriately or if verbal, speaks
1= The child moans or abnormally cries
0= No vocal response to pain
o Eye movement
1= The child watches or follows objects
0= Fails to follow or watch.
Overall
• First and foremost resuscitate the child following steps outlined above
• When the child is stabilized, investigate him/her to establish the cause or consider referral
to hospital.
Investigations
The following are the investigation of coma in child.
• Blood Smear (BS) or rapid test for malaria parasites
• Random blood sugar
• Lumbar puncture
Treatment
Treat the cause
o Treat hypoglycaemia with 10% Dextrose 5ml/kg IV as a bolus dose
o Broad spectrum antibiotic – Chloramphenicol 25mg/kg IM/IV
o Quinine 10mg/kg IM