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IMMEDIATE LIFE-THREATENING NEUROLOGICAL CONDITIONS

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THE COMATOSE CHILD

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GENERAL CONSIDERATIONS

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A rapid and systemic approach to assessment and management of coma in the pediatric patient is of paramount importance guided by initial clinical evaluation. Careful monitoring and continuous reassessment are necessary. The initial assessment should be performed at the same time as initial basic medical therapy such as placement of monitoring devices and intravenous access.

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Coma is characterized by decreased levels of arousal and may be graded by clinical findings. The Glasgow coma scale (GCS) is a common and easily used scale in the adult patient and may be adapted to pediatric use (Table 37–1).

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The most common cause of coma in children is infectious, and rapid management of potential infectious causes is recommended (Table 37–2).

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Table Graphic Jump Location
Table 37–1.Pediatric Glasgow coma scale.
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Table Graphic Jump Location
Table 37–2.Common causes of coma.

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