Management of unconscious childUnconsciousness (coma) is usually graded according to a standard scale so that changes in the level of consciousness can be evaluated accurately. Glasgow coma scale is commonly used evaluation system. In this scale : -Total score = Eye opening + motor response + verbal responseThe best response is scored. The lowest score is 3, and the highest is 15 (fully conscious child). A score of 8 or less suggests severe brain dysfunction, a score of 9-12 moderate brain dysfunction and a score of 13-15 minor brain dysfunction.InvestigationsIf the cause of coma is unknown, following investigations may be required : -Lumbar puncture ECG Skull radiography/CT/MRI Cervical spine imagingBlood is drawn for a CBC, electrolyte determination, toxicology tests, blood gas analysis, BUN and cross matching. Management Care of the child in coma is directed towards maintaining body function in optimal state until the child regains consciousness. Management includes : -1) AirwayAs a general rule, place the child on his/her side to reduce the risk of aspiration. Oral suctioning to remove mucus from the mouth and pharynx may be necessary.If Glassgow score is 8 or less and clinical circumstances do not suggests improvement then intubation is indicated to secure airway.2) reathingOxygen is given especially when oxygen saturation is low.3) CirculationVenous access is obtained.Signs of shock are assessed and treated as indicated.4  rugs and specific therapyAfter maintenance of breathing and circulation, specific therapy is given e.g., antibiotics for infection, dextrose in hypoglycemia, naloxone in opiates poisoning etc.