Emergency management of acute coma in children

A deteriorating neurologic state in a child with an acute brain insult is a life-threatening situation, and the decisions made during the first few minutes of management will frequently determine the outcome. Often, the family physician is the first person contacted by the parents to evaluate the sudden change in a child. Attention must be first directed toward ensuring an airway and maintaining adequate circulation. Computed tomographic study, toxicology screen and determination of acid-base status should follow. Possible causes of acute coma in children include trauma, child abuse, intracerebral hemorrhage, tumor, meningitis and poisoning.