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Preparation for transfer to hospital… now what?

Ok,  we need to prepare him, in case he vomits again on our way in. He had a few episodes of vomiting ok, good point We got the suction ready, we can just always tilt the scoop on the way 
so an IGel in case you need it let’s get the airway adjuncts out as well
It’s down here ready, yeah
anything else? get the suction ready as well  yes so in case his GCS drops and he may have a  seizure from the head injury so what we’ll do, if he does start to seize and vomit we can tilt him on the scoop as well and I'll get some benzodiazepines ready for the journey just in case and we'll get some access for him as well we may want to consider going to a nearer hospital… yes absolutely, if he  starts to deterioration we’ll divert to a closer centre. I'm a bit concerned about this marking on his abdomen, a liver like or some abdominal trauma which is causing to bleed internally.
So we’ll keep a close eye on him, on his blood pressure and things and consider some fluids on the way in, I think we'll have to continually reassessment yes absolutely,  in regards to his intracranial pressure, we'll keep him in this kind of position as such and we won't do too much to him in terms of position or anything that will raise the ICP ok As they are preparing to leave, Toby starts to have a fit. To begin with, his hands go stiff, and then he starts to shake Oh my God what’s going on? What’s all the stuff coming out of his mouth?
Dad, don’t worry at the moment, we’re just going to sort his airway out so we can help him with his breathing a little bit, ok? panickedToby? No, No, I do appreciate it, all you’re doing Ok Toby, just going to pop this mask on your face, well done, that’s it
I’m going to get that diazepan ready for you now, going to give that him just to stop him having a seizure, alright? I’m going to pop that into his ACF where the cannula is, alright Yep Shall we work out this for his weight, ok?

En route Toby begins to have a seizure. Remember, not all seizures are classic tonic clonic seizures and may present a diagnostic challenge when they fall outside the standard pattern.

  1. How would you address this new problem?

  2. What system would you use to assess him and what definitive treatment would you give?

  3. The paramedics decide to give Toby intravenous diazepam. What other treatments are available?

  4. What do you understand about the concept of neuro protection?

Share your thoughts below.

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Emergency and Urgent Care for Children: a Survival Guide

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