Neurologic Emergencies
Neurologic emergencies require rapid recognition of altered mental status and seizure management. Candidates must know the stepwise approach to status epilepticus, the importance of checking glucose, and the recognition of raised intracranial pressure signs. Understand the differential for altered mental status, including hypoglycemia, ingestion, infection, trauma, and shunt malfunction.
Key concepts include the pediatric Glasgow Coma Scale, the approach to the first unprovoked seizure, and the recognition of febrile seizures and their generally benign prognosis. Know the red flags for serious causes: fever with neck stiffness, focal deficits, prolonged postictal state, and petechiae.
Traps: delaying benzodiazepines in status epilepticus; missing hypoglycemia as a cause of seizures; and attributing altered mental status to a benign cause without considering ingestion or infection. Another trap is over-imaging low-risk febrile seizures while under-evaluating a child with focal findings.
Worked example: a child seizing for more than five minutes should receive a benzodiazepine at the appropriate weight-based dose, with airway support and glucose check, and escalation to a second-line agent if seizures persist. Rule of thumb: time the seizure, treat early, and always check glucose. Recognize that a prolonged postictal state or focal deficit warrants further evaluation.