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Pediatric Altered Mental Status - Dr. MacNeill

10/31/2013

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PictureThere is a lot to think about... but don't forget the sugar!!
BASICS
  • Brain needs glucose, O2, electrolytes, nl electrical activity, no structural defects, no inflammation or infection
  • Transient vsPersistent Change in MS
  1. Transient - usually benign, common, think electricity and perfusion
  2. Persistent - dangerous, structural, metabolic, electrical


Seizure
  • CT?
  • Emergent CT - Less than 2 yrs, focality, abnl neuro exam, status, evidence of increased icp
  • Infant sz hard to detect- behavioral arrest, hypomotor, pallor, cyanosis, repetitive movt
  • Set the expectation -
  1. Outpt EEG and MRI only if EEG supports the need or syndrome
  2. Return to ED for sz in next 24hr, or last more than 5 min.
  3. Send home with diastat.

Syncope
  • Lifetime incidence  up to 40%,
  • Plumbing issue - decreased Cardiac Output, decreased TPR. Reflex syncope is combo of both
  • Sudden cardiac death - 50% with CV cause
  1. HOCM - deep and narrow q waves in lateral leads, tall r waves in v1, high left ventricular voltage, syncope not always exertional, atypical CP, 1/2 family hx, Doppler echo for dx
  2. Anomalous coronary arteries - 1/2 sx before death, syncope with exercise, nl EKG, ventric arrhythmia, dx by echo or CTA 
  3. Long QT syndrome - stress syncope,exercise, bradycardia, 1/3 will have nl EKG, 10% of healthy people have long QT
  4. Brugada - rbbb and downs sloping ST in V1-V3, vtach, fib, triggers for Dysrhythmia sleep and rest when Vagal tone is high, fever, check lytes
  5. Arrhythmogenic RV Dysplasia - autosomal dominant, RV myocardium deposition with fibrofatty tissue, widened QRS
  6. Catecholeminergic polymorphic VTACH - Rare, structurally normal, nl EKG, family hx
  7. Myocarditis - recent febrile illness rash fatigue, PE nl, EKG ectopy, nl sinus tach, cardiac MRI

Red flags of syncope
- exertional (not after the exertion), family hx, cp, palpitations, syncope, brought on by sudden loud noise, febrile illness, abrupt syncope, <10 years

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction