A 6 year old is brought in to your ED after a concerning episode at home, suggestive of a seizure, witnessed by his mother.
On arrival, he has an altered mental state, no temperature currently with tachycardia and hypertension.
Allocate team and prepare for arrival
On arrival – concurrent assessment and management
Address any immediate life threats, ABC approach
Broad differential diagnosis
Consider empiric treatment
CNS – meningitis, encephalitis, abscess, mass, AVM rupture, HI
Infection – sepsis, pneumonia, UTI, abdominal source, CNS
Metabolic/ Endocrine – glucose, DKA, dehydration, hypoxia
Drugs and toxin ingestion
Cardiac – arrhythmia, congenital
Seizure – febrile, epilepsy, secondary to any above
attention to ABC – oxygen, fluid bolus, glucose, manage airway
bloods – this patient has significant neutrophillia which cannot be explained by seizure alone, also SIADH like picture.
depends on management – ICU/HDU vs Paeds admission