Is this an emergency urgent or routine clinical condition An

emergency case requires the same attention to detail as a routine case; however, the pace of actions and order in which they are completed differs. Remember the ABCs (airway, breathing, circulation).

B. What is the clinical description of the lethargy? Obtain a thorough description of patient's lethargy and events prior to presentation. This description should be obtained from child, parent, and a witness if possible. When did lethargy begin? Were there any associated activities such as movements of the face or body? Has child had any similar episodes previously? Were there any precipitants to this episode?

C. What is the cause of this alteration in patient's interaction with environment? Lethargy can be the manifestation of a number of clinical conditions, ranging from toxic and metabolic conditions to seizures; the differential diagnosis is broad. Conditions that can present with lethargy include increased intracranial pressure, intoxication, and systemic medical, post-traumatic, vascular, behavioral, and sleep disorders.

D. Pertinent Historical Information. Prenatal and neonatal course may identify risks for long-term neurologic sequelae.

1. Prenatal history. Did mother receive prenatal care? Is there any history of maternal medication use or substance abuse during pregnancy? Maternal medical complications during pregnancy? Was pregnancy full term? Any complications during the delivery?

2. Neonatal history. Were developmental milestones achieved at appropriate ages? Is there any significant medical or surgical history? History of trauma?

3. Family history. Is there a family history of neurologic disorders?

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