📊 Initial Stabilization (ABCs)
• Airway, breathing, circulation
• Blood glucose (bedside) – hypoglycemia is rapidly reversible cause
• Naloxone for suspected opioid overdose
• IV access, oxygen, cardiac monitoring
⚠️ Red Flags – Increased ICP / Structural Cause
• Cushing triad: hypertension + bradycardia + irregular breathing
• Unilateral fixed/dilated pupil, papilledema, CN VI palsy
• Focal neurologic deficits, posturing (decorticate/decerebrate)
• Bulging fontanel in infant
🩺 Common Etiologies by History
• Trauma → intracranial hemorrhage, shaken baby
• Fever + nuchal rigidity → meningitis
• Ingestion → toxidromes (opioids: pinpoint pupils, apnea; anticholinergic: dilated pupils, delirium)
• Diabetic ketoacidosis: polyuria, polydipsia, Kussmaul breathing, hyperglycemia
• Metabolic: inborn errors (vomiting, acidosis, hyperammonemia)
📋 Diagnostic Workup
• Bedside glucose (first!)
• Head CT for trauma, suspected bleed, or mass (before LP if increased ICP suspected)
• LP after CT if no mass effect/meningitis suspected
• Labs: electrolytes, glucose, calcium, ammonia, LFTs, ABG, toxicology screen, blood culture
📌 Decision strategy: ABCs first, then glucose. Head CT before LP if concern for increased ICP (focal signs, papilledema). Reye syndrome (post-viral, aspirin use, elevated LFTs, ammonia) is now rare due to decreased aspirin use in children.