Monitor neuro status of pediatric patients
(Editor's note: This is the second of a three-part series on trauma care in the ED. This story covers neurological assessments in motor vehicle accidents. Last month, we covered violence-related trauma including suspected abuse. Next month, we'll cover self-inflicted trauma.)
When monitoring a child's neurological condition after a motor vehicle accident, you need some specific information to determine what your "index of suspicion" should be, says Cam Brandt, RN, MS, CEN, CPN, emergency services educator at Cook Children's Health Care System in Fort Worth, TX.
She suggests using the pneumonic "AVPU" for an overall assessment of level of consciousness, standing for:
- A: Is the child awake/alert?
- V: Does the child respond to verbal stimuli?
- P: Does the child respond to painful stimuli only?
- U: Is the child unresponsive?
Also, obtain this additional information, advises Brandt:
- Did the prehospital personnel or field triage report include loss of consciousness or significant vehicular intrusion?
- What was the speed of the vehicle?
- Was there a death in the patient's passenger compartment?
- Was this an automobile-pedestrian or automobile-bicycle crash?
- What is the patient's age-appropriate Glasgow Coma Scale score?
- What is the patient's pupillary size and response to light, motor strength/response, and assessment of head circumference compared to the patient's normal assessment?
To improve your neurological assessment, do these three things:
- Consider the patient's age.
Compare your assessment to what would be expected in a "normal" child of that approximate age. "Age-appropriate, serial assessment is key," says Brandt. "The neurological assessment of a 6-month-old is very different from that of a 9-year-old. Variations in assessment should be further explored."
- Communicate your findings in concrete, objective terms.
Instead of saying, "He's not acting right," more detailed observations such as, "I'm noticing slurred speech and a delay in responding to commands" provide more effective communication and consistency in assessment, says Brandt.
- Find out what the caregiver thinks.
Compare your assessment to that of the primary caregiver. For example, if you notice a decrease in level of consciousness, Brandt recommends asking the parent or caregiver a question such as, "I see that Johnny is acting rather sleepy. Is that normal for him?" The parent can answer, "It is nap time, so he is very tired," or they can answer, "No, this is not normal for him."
"Consider these answers with the rest of your assessment for a more complete picture," says Brandt. "Children with special health care needs should be assessed based on their normal state of response, which is best known by the caregiver."
Take these steps if child's One of the first signs of a deteriorating neurological status in a pediatric patient might be a change in level of consciousness. "The child who was originally aware of his or her surroundings but is now responding only to painful stimulation warrants closer evaluation," says Cam Brandt, RN, MS, CEN, CPN, emergency services educator at Cook Children's Health Care System in Fort Worth, TX. Other more subtle signs, such as change in vital signs or posture, also should be noted, adds Brandt. She advises taking these three steps if you notice any change in neurological assessment: 1. Note the patient's previous assessment and any subsequent treatments or interventions, such as medications. Report changes in posture, responsiveness, pupillary response, and motor movement, says Brandt. "Even subtle changes should be reported to the physician and other members of the health care team," she adds. |
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content