What (if any) additional diagnostics and/or interventions would you

initiate?
Assess GCS and ability to maintain airway- provide
oxygen/intubate as necessary
Head CT
LP
Blood cultures, coags, CRP, lactic acid, ethanol concentration
EEG
Urine toxicology
What consults may be helpful in providing care for this patient and
family?
PICU
Neuro
ID
What are your top 3 differentials at this point? Please explain your
rationale.
Systemic inflammatory response syndrome (SIRS)
o SIRS is a widespread inflammatory response that can be
associated with infection. The presence of two or more of
the following criteria defines SIRS; Temperature (measured
by rectal, bladder, oral, or central probe) of >38.5C or
<36C, tachycardia/bradycardia, mean respiratory rate
normal for age or mechanical ventilation for an acute
pulmonary process, and leukocyte count elevated or
depressed for age, or >10 percent immature neutrophils.
One of criteria must be abnormal temperature or leukocyte
count (Pomerantz, 2015).
Head trauma
o History of recent pool activity and under the supervision of
babysitter prior to initiation of symptoms.
o History of AMS and nausea/emesis and the physical exam
positive for decreased pupillary reaction indicates possible
head trauma.
Ethanol toxicity
o In children, the classic triad of signs of ethanol intoxication
includes coma, hypoglycemia, and hypothermia
(Fernandez, 2013).
Reference
Ainsworth, C. R. (2015). Head Trauma. Medscape. Retrieved from
http://emedicine.medscape.com/article/433855-overview#a9
Fernandez, Elizabeth (2013). Ethanol Toxicity Clinical Presentation.
Medscape.

Retrieved from http://emedicine.medscape.com/article/1010220clinical

Pomerantz, W. J. & Weiss, S. L. (2015). Systemic inflammatory response
syndrome
(SIRS) and sepsis in children: Definitions, epidemiology, clinical
manifestations, and diagnosis. Up to Date. Retreieved from
http://www.uptodate.com/contents/systemic-inflammatoryresponse-syndrome-sirs-and-sepsis-in-children-definitionsepidemiology-clinical-manifestations-and-diagnosis?
source=search_result&search=SIRS&selected Title=1~125