(4) Neurological state. Perform a thorough neurological examination. This
examination will be repeated several times. The changes in the child's condition and
the direction of those changes are very important. When you are doing the neurological
examination, be particularly attentive to the following areas.
(a) Position of the child. In what position was he found? His position
can sometimes indicate certain injuries.
(b) State of consciousness. This is part of the neurological
examination and is mentioned in paragraph b(1) above.
(c) Speech. If the child is conscious, is his speech clear or garbled?
Even if his words are not in the proper order, is he still able to understand what is said
to him? Can he follow simple commands; for example, "Squeeze my hand."
(d) Movement and sense of pain. When you are moving the child's
extremities, does he know that you are moving his fingers or toes up or down? Does he
realize that you are pricking his toe with a pin? Does an unconscious child react to
painful stimuli; for example, pin pricks.
(e) Pupils of the eyes. Look at the child's pupils to see if they are equal
in size. Are his pupils abnormally constricted or dilated?
Eye movements. Can the child's eyes follow your moving finger?
c. Treatment. The goal of treatment is to maintain the airway and prevent the
patient from injuring himself.
Sponge the child with lukewarm (tepid) water if he has a fever.
(2) Place the child on the floor away from objects that can cause injury. DO
NOT restrain him.
Maintain the child's airway.
Administer oxygen to him and assist with ventilations, if necessary.
Start an IV TKO normal saline.
Be prepared to give D/50 (50 percent dextrose injection) in the dosage
of 1 ml/kg.
(7) Once in the treatment facility, if the child's seizures do not stop, prepare
to give diazepam (Valium) in a dose of 0.3 mg/kg. Give this medication in a slow IV
over a period of 1 to 3 minutes.