Presentation

Altered Level of Consciousness

Key Conditions

Key conditions are the core conditions that the Paediatric Undergraduate and Clerkship Directors of Canada (PUPDOC) felt are essential for graduating medical students to know. The Key Conditions are neither a differential diagnosis nor a clinical approach. They highlight conditions that may be unique to paediatrics, that are essential, or that are common. Key Conditions can present in a number of ways – each is listed as under the most common Clinical Presentation.

Clinical Approach

Clinical approaches represent one of many methods to think through a clinical presentation, and narrow down a differential diagnosis. There are many conditions that can present with similar symptomatology. These presentations are not meant to contain an exhaustive list of differential diagnoses, but rather outline how to think through patient signs and symptoms, and understand some of the most common and important Paediatric conditions. There are many different ways to approach any clinical presentation, and these approaches are not meant to replace clinical judgement.

Vignette

A 9 year old boy is found unconscious at home by his parents. EMS was immediately called, and you are assessing him in the emergency department

Diagrams

Pre-Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Lectures

Small Groups

  • Diabetic Emergencies Course 4
  • Pediatric Emergency Medicine Course 6
  • Tumours and Bleeds Course 5

Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Objectives

By the end of the Paediatric Clerkship, a medical student will be able to:

  1. Propose a differential diagnosis, and an investigation and management plan for a paediatric patient with an altered level of consciousness.
  2. Clinically recognize a patient with a concussion and counsel the patient and family in return to school and play guidelines.
  3. Propose a differential diagnosis and an investigation and management plan for a paediatric patient with hypogylecemia.
  4. Propose an initial investigation and management plan for a patient with suspected metabolic disease.

Half Day Cases

  • A 3 year old was found in the backyard with decreased level of consiousness
  • An 8 year old has had a fever for 3 days and has been unwell. This morning, parents found him lying on the ground in his bedroom. They called 911 and are now in the Emergency Department
  • A 4 year old has been sick with vomiting and diarrhea for 4 days. This afternoon, they have been getting progressively more tired and family is having a difficulty time rousing him from his nap

Resources

The following resources have been reviewed and collated by canuc-paeds. These resources are aimed to provide information at the level of the medical student. These include overviews of topics, clinical resources, and useful guidelines that contain relevant materials.

Papers 

  • Altered States of Consciousness. Avner JR. .
    Pediatrics in Review 2006; 27 (9): 331-338.
    Approach to altered level of consciousness. Common causes, differential diagnosis, table on herniation syndromes and management.

Videos 

No videos.

Clinical approaches to Altered Level of Consciousness?

Any incorrect information? Let us know

Last updated 08 August 2021.