After completion of this session the participant should be able to:
C represents “Coma and Convulsion”. In the ABCCCD system
The following signs indicate impaired neurological status: coma, lethargy, and convulsions.
|Key fact for providers – how to assess the NYI for coma and convulsion
To help you assess the conscious level of a child a simple scale (AVPU) is used:
A Is the baby Alert? If not,
V Is the baby responding to Voice? If not,
P Is the baby responding to Pain? (rub the sternum)
U The baby who is Unresponsive to voice (or being shaken) AND to pain is Unconscious.
This assessment depends on your observation of the child and the history from the parent. Children who have a history of convulsion, but are alert and not currently convulsing, need a complete clinical history and investigation, but no emergency treatment for convulsions. Sometimes, in infants, the seizures are subtle, jerky movements may be absent, but there may be twitching (abnormal facial movements), apnoea, lip smacking or abnormal movements of the eyes, hands or feet.
Among neonates with seizures, the reported ranges of median prevalence are the following: hypoxic-ischaemic encephalopathy (HIE): 38-48%; hypoglycaemia: 3-7.5%; hypocalcaemia: 2.3-9%; central nervous system (CNS) infections:e.g. meningitis 5.5-10.3% (7).
|Manage the airway||Manage the airway|
|Position the child||Position the child|
|Consider an airway||Check the blood sugar|
|Check the blood sugar||Give IV glucose if low|
|Give IV glucose if low||Give anticonvulsant if still seizing|
|Increases with tactile stimulation, wind, light and noise||Does not change in response to stimulation|
Treatment of coma and convulsion are similar and will be described together
To manage the airway of a convulsing child gentle suction of secretions should be done, the infant put on his side and oxygen started. Do not try to insert anything in the mouth to keep it open.
Algorithms for managing convulsions < 2 weeks and > 2 weeks Wall charts
Key fact for providers
|Inj. Phenobarbitone intravenous dose (200mg/ml)
Dose is 20mg/kg
|Weight of Infant||Initial dose||Repeat dose|
|2kg or less||0.2ml||0.2ml|
|2 to 4kg||0.3ml||0.3ml|
|Diazepam given rectally 10mg/ 2ml solution|
|Age/ weight||Dose 0.1ml/kg|
|2 weeks to 2 months||(<4kg) 0.3ml|
May cause respiratory arrest
|Paraldehyde given rectally 10mg/ 2ml solution|
|Age/ weight||Dose: 0.2ml/kg IM, 0.4ml/ kg PR;
Injection 10 ml ampoules
|2kg||0.4mls IM or 0.8mls PR|
|3kg||0.6mls IM or 1.2mls PR|
|4kg||0.8mls IM or 1.6mls PR|
Do not leave in plastic syringe for longer than 10-15 min