PE24.{5,15} | Unconscious Child — Summary & Reflection

KEY TAKEAWAYS

An unconscious child requires simultaneous assessment and treatment. The key framework is:
• Assess consciousness with AVPU (4-point: A/V/P/U) and paediatric GCS (3–15; coma threshold ≤8)
• ABCDE assessment — airway (recovery position or jaw-thrust if trauma), breathing, circulation, disability (BGL + neurological signs), exposure (rash, fever, trauma)
• AEIOU-TIPS — systematic aetiological approach (Alcohol/acidosis, Epilepsy, Insulin/hypoglycaemia, Overdose, Uraemia, Trauma/Temperature, Infection, Psychogenic, Stroke/Structural)
• DON'T EVER FORGET hypoglycaemia — BGL in the first 60 seconds; treat with 10% dextrose 5 mL/kg IV if <45 mg/dL
• Seizure control: diazepam IV 0.3 mg/kg (max 10 mg) slow injection; PR 0.5 mg/kg if no IV access
• Positioning: recovery position (no trauma); jaw-thrust + log-roll (trauma)
• CNS infection suspected: empirical ceftriaxone immediately after blood cultures; LP after stabilisation
• Serial GCS monitoring every 15–30 minutes; falling GCS = active deterioration

REFLECT

Think about a moment in your training when you had to act quickly under uncertainty — when you did not yet have all the information but someone needed you to do something now. How did that feel? Paediatric emergencies put that feeling on a time axis: every 60 seconds of indecision about a reversible cause has a neurological cost. Reflect on how structured frameworks (ABCDE, AEIOU-TIPS) change that calculation — they compress the search space so you can act confidently without paralysis. What part of today's emergency sequence do you feel least confident executing? What would it take for you to build that confidence before your first real paediatric emergency case?