Limiting the brain injury is the primary goal to treat comatose patients. Treatments for severe etiologies (eg, hypoglycemia, increased intracranial pressure, bacterial meningitis) are often initiated empirically. The assessment and management of children in a coma are performed jointly in practice and is different from those of adults. The primacy of ABC's (airway, breathing, circulation) applies to the coma like other emergency conditions.
Airway Stabilizing the patient by securing the airway and providing adequate ventilation may be lifesaving and also may limit neurologic injury. This is attained by repositioning the child to open the airway but often requires intubation (if GCS>8) to ensure adequate ventilation and to prevent aspiration of secretions or gastric contents. If trauma is suspected, the cervical spine should be stabilized with a collar while securing the airway.…
