Pediatric Altered Mental Status: Fill & Download for Free

Emergency Medical Service personnel are trained to use a triage system called: The START (Simple Triage And Rapid Treatment) triage system. The tags that you see deployed during mass casualty event are based on this system.The start triage system employs 4 colors (each with their own meaning and criteria) for easy identification of victims.GREEN (Minor)-Green represents any patient that is ambulatory on scene which means that they fall under the category of "the walking wounded". These patients usually have minor injuries that are not life threatening and can usually help with the treatment of their own injuries. Green patients will be the last ones to get transported to the hospital.YELLOW (Delayed)-Yellow represents any patient that has a significant injury but this injury will not be fatal any time soon. These patients have adequate breathing, circulation, and no altered mental status. These patients will go to the hospital before any green patient but their transport may be delayed depending on the availability of resources.RED (Immediate)-Red represents a patient who has a life threatening injury that can be reversed with immediate intervention. These patients usually have inadequate breathing, circulation, and an altered mental status. These patients will be the first to be sent to the hospital as resources become available because they have the highest possibility of dying.Black (Expectant)-Black represents a patient who is deceased or unlikely to survive due to the severity of his/her injuries. These patients are apneic (even after opening the airway) and pulse less. These patients are usually left alone until arrangements by incident command are made for body removal.If you want a detailed diagram explaining the criteria that is used to place patients in each category look here (START Adult Triage Algorithm). Also, here (START Triage - Tag) is an example of a standard START triage tag.Hope this answered your question!JG the EMT.PS. It is important to note that there is a different triage system for children because they are very different from adults. This one is called the JUMP-START triage system. For more info on this one look here: JumpSTART Pediatric Triage Algorithm

Several studies have shown that toddlers who had developed meningitis by the age of two were at risk for poorer functioning as children and adolescents compared with toddler who had never suffered from the disease. One such study showed that toddlers who had suffered from meningitis by age 18 months performed more poorly on neurocognitive, educational and intellectual measures. Those who had suffered from meningitis in early life also exhibited increased depression, anxiety and psychotic symptoms and were rated as having more psychological and behavioral problems compared to their peers (Khandaker, Stochl, Zammit, Lewis,, & Jones, 2015).It is not unusual for patients diagnosed with meningitis to suffer from altered mental status and some types of meningitis are associated with acute psychotic confusion. Other common symptoms include irritability, lethargy, excessive sleepiness, and poor eating (CDC, 2014). However, these symptoms, can be tied to the pathophysiology of the disease itself and are not believed to indicate separate syndromes. As meningitis has known physical causes that have not been found to also cause such mental disorders as bipolar disorder or schizophrenia when such mental disorders do co-occur with meningitis it is a matter of coincidence. In general, those with mental health problems are equally likely to be exposed to agents that cause meningitis as the general population. There is also no evidence that spinal meningitis causes such mental disorders as bipolar disorder or depression in terms of physiological causation.However, the experience of having meningitis has been associated with emotional, behavioral and psychological aftereffects in about a third of patients of which 13 percent report the problems were long term. These problems were the most commonly reported after-effects of the disease (Meningitis Research Foundation, 2010). These effects were found in children and adolescents as well as adults (Borg, Coen, Booy, & Viner, 2009). Addition, as many as 15 percent of children and half of parents have been shown to develop PTSD after hospital discharge (Garralda, Gledhill, Nadel, Neasham, O’Connor, & Shears, 2009). It is important to note that these types of problems are commonly found after experiencing a life threatening illness and are not specific to spinal meningitis although they occurr as common after-effects of the disease.ReferencesBorg, J., Christie, D., Coen, P.G., Booy, R., & Viner, R.M. (2009). Outcomes of meningococcal disease in adolescence: prospective, matched-cohort study. Pediatrics, 123: e502-9.Centers for Disease Control and Prevention, (2014). Meningitis.Garralda, M.E., Gledhill, J., Nadel, S., Neasham, D., O’Connor, M., Shears, D., (2009). Longer-term psychiatric adjustment of children and parents after meningococcal disease. Pediatric Critical Care Medicine, 10: 675-80.Khandaker, G. M., Stochl, J., Zammit, S., Lewis, G., & Jones, P. B. (2015). A population-based prospective birth cohort study of childhood neurocognitive and psychological functioning in healthy survivors of early life meningitis. Annals of epidemiology, 25(4), 236-242.Meningitis Research Foundation, (2010). Impact of Meningitis: Findings and Recommendations from the Member Survey.

This is from a 2 second Google Search:Rapid Diagnosis: Pinpoint PupilsAPRIL 23, 2009 BY STEVE WHITEHEAD 41 COMMENTS77EmailShareAbnormally constricted or “pinpoint” pupils are a great finding for our rapid diagnosis series. There are many things that can cause the pupil to abnormally dilate. Very few things will make the pupil abnormally constrict. Constricted pupils are a doorway to a very short list of ailments and with a bit of background you should be able to hang your hat on one fairly quick.How do we assess for “pinpoint” pupils?Recall that the pupil should be mid-range and reactive under normal lighting conditions. When subjected to bright light, the pupil will constricted to reduce the volume of light entering the iris. In darkness the pupil will dilate to allow as much ambient light in as possible. Pupils smaller than 2mm in diameter under normal lighting conditions can be considered “pinpoint”. Any pupil that responds to changes in lighting conditions with 1mm of movement or less can be considered minimally reactive or nonreactive.To assess for pinpoint pupils we need to subject the pupil to darkness by asking the patient to close their eyes or covering the patients eye. When we return the light source to the pupil we expect the pupil to be larger and rapidly return to its original size. If the pupils remain <2mm in diameter through the changing light conditions we have a “pinpoint pupils” finding. The fancy medical term for this phenomenon is abnormalmiosis.If the patient has bilateral pinpoint pupils consider the following possible etiologies:1.) Opiate use / abuse / overdoseOpiate class drugssuch as Heroin, Fentanyl, Codeine, Methadone and Morphine stimulate the parasympathetic side of the autonomic nervous system and cause pupil constriction. While it varies depending on your response area, most of the constricted pupils that you encounter in the field will be opiate induced.Look for possible sources of drug use or abuse from prescription meds to illicit drugs. Evaluate the patient for track marks across the veins and the scene for paraphernalia like spoons, tin foil, matches, syringes and makeshift tourniquets. Don’t rule outopiates in pediatrics. Miosis in combination with depressed respirations are the hallmark signs of opiate overdose.It’s also worth mentioning that if you happened across this page looking for information about opiate addiction, there are good people who can help you overcome the challenges of opiate withdrawal and addiction recovery. Now let’s get back to our list.2.) Pontine HemorrhageThe pons is a knob-like structure located at the front of the brain stem. Intracranial hemorrhage in the area of the pons will typically cause bilateral pupil constriction. Intracranial hemorrhage can have both traumatic and atraumatic origins.Consider pontine hemorrhage in the presence of high mechanism head trauma and patients with a history of vascular disease, strokes and abnormal bleeding. If you find miosis with altered mental status that does not respond to Narcan administration, consider the possibility of a pontine hemorrhage.3.) Organophosphate / Chemical / Nerve Agent ExposureThere are a few classes of chemicals that cause parasympathetic over-stimulation and, therefore, pinpoint pupils. Organophosphate chemicalsare the most common. Virtually any phosphorous-containing organic compounds are considered organophosphates.These compounds are effective pesticides used in agriculture. They are widely used because they break down easily in the environment unlike their cousin DDT. Malathion and parathion are examples of organophosphate pesticides. These chemicals kill insects by disrupting their nervous system function. Unfortunately they kill humans in the same manner.They can be absorbed through the skin, inhaled and ingested. Once absorbed they shut downacetylcholinesterase production and put the parasympathetic system into overdrive. This will create the classic SLUDGE presentation, characterized by excessive salivation, lacrimation (tears), urination, defecation and emesis. And two other telltale signs (If you needed more) … muscle cramps and pinpoint pupils.Many of the never agents used in terrorist attacks are organophosphate in nature including Sarin and VX gas. If your patient is involved in farming or agriculture, drank an unknown chemical or was a victim of a chemical attack, check for pinpoint pupils and consider organophosphate poisoning.So there you have it. OK, sure, we’ve left out a few possibilities here. Hopefully you’ll forgive me for passing over Horner’s Syndrome, Neurosyphilis and a few other obscure brain abnormalities that will cause abnormal pupil constriction. No diagnosis is a certainty, but when you find those pinpoint pupils, start with the big three. Now go look at some pupils.I hope you found it useful!