Altered level of consciousness Flashcards
Febrile convulsion
Defined - brief, generalised seizures associated with a febrile illness, in the absence of any CNS infection or past hx of febrile seizure
Occurs in 3-4% of children from 6 m to 5yrs
Recurs in 1/3
In otherwise health children, FC are not accompanied by an increase risk of intellectual disability, cerebral palsy, other neurological disorder or death.
Modest increase in risk of epilepsy.
Types of febrile convulsion
Simple - brief generalised tonic clonic and single one per illness
Complex - Either focal, greater then 15 min, or multiple in a 24 HR period. Incomplete recovery within an hour or recurrence in same illness
Mx for Febrile convulsions
Underlying cause
- Search for cause of fever - commonest is viral
- General temperature control eg remove excess clothing. Only paracetamol if child is uncomfortable.
Seizure - If duration greater than 10 mins. IV or rectal diazepam 0.2-0.4mg/Kg.
Reassurance - only 3% go on to develop epilepsy compared to 0.5%.
Education - low risk of neurological complication and excellent prognosis for eventual remission. 1:3 risk of recurrence. She will outgrow them. Advise on how to mx.
Management of Seizure at home: lay on side, don’t force her month open, remove any danger, call an ambulance, undo tight clothing around neck, time the seizure, stay with patient and try to reassure.
Follow up visit to help explain things afterwards.
What are the risk factors that make the development of epilepsy in a child with febrile convulsion more likely.
Previous abnormal neurological development
A hx of epilepsy in first degree relatives.
Prolonged Febrile convulsion greater then 10min
Focal features present during or after the febrile convulsion
Multiple convulsions during a single febrile episode
DDX for fits
Non paradoxall?
Syncope
TICS
Breath holding spells
Types of breath bonding spell
Cyanosis - cry and then turn blue
Pallor - sml bump makes then pass out vagal vagus.
Triad of hypoglycaemia
Lethargy - coma
Confusion and agitation
Seizure
Triad of hyperglycaemia
Polyuria
Polydipsia
Blurred vision
Driving restrictions for diabetic
HbA1c less than 9 Knows how to recognise high and low Test regularly If BSL higher than 15 or lower then 4 Stop, treat, wait 2 hrs and retest.
Resus of a child
Airway - check secretions or strider, foreign body or unprotected airway
Breathing - RR, Recession and accessory muscle use, O2 stats, auscultation
Circulation - colour, HR, CRT peripheral and central, temp of hands and feet and BP
Disability - Pupils, limb tone and movement, AVPU and GCS
ENT assessment
Temperature assessment
Tummy assessment
Blood glucose assessment
Cause of ALOC
V - aneurysm or AV malformation, embolus I - Meningitis, Encephilitis, abscess, Malaria, Rabies T - trauma A M - metabolic, dehydration, glucose, Na, Ca, Liver failure I - Drug N - primary tutor C O - Seizure
Tx for raised Intracranial pressure
Raised head of bed Fluid balance - avoid over hydration Manitol if serum is less than 325mOsm/L BP maintained in range Maintain PCO2 May need dexamethasone IDC Maintain glucose and temp NGT to prevent aspiration SKID to avoid bed sores
Triad of hypoglycaemia
Lethargy - coma
Confusion and agitation
Seizure
Triad of hyperglycaemia
Polyuria
Polydipsia
Blurred vision
Driving restrictions for diabetic
HbA1c less than 9 Knows how to recognise high and low Test regularly If BSL higher than 15 or lower then 4 Stop, treat, wait 2 hrs and retest.
Resus of a child
Airway - check secretions or strider, foreign body or unprotected airway
Breathing - RR, Recession and accessory muscle use, O2 stats, auscultation
Circulation - colour, HR, CRT peripheral and central, temp of hands and feet and BP
Disability - Pupils, limb tone and movement, AVPU and GCS
ENT assessment
Temperature assessment
Tummy assessment
Blood glucose assessment
Cause of ALOC
V - aneurysm or AV malformation, embolus I - Meningitis, Encephilitis, abscess, Malaria, Rabies T - trauma A M - metabolic, dehydration, glucose, Na, Ca, Liver failure I - Drug N - primary tutor C O - Seizure
Tx for raised Intracranial pressure
Raised head of bed Fluid balance - avoid over hydration Manitol if serum is less than 325mOsm/L BP maintained in range Maintain PCO2 May need dexamethasone IDC Maintain glucose and temp NGT to prevent aspiration SKID to avoid bed sores
Hx Q to ask for suspected febrile convulsion
I'd if seizure or rigor Febrile vs a febrile CNS infect Simple vs complex ID cause Hx fever
Ex for febrile convulsion
Neurological exam
Check for source of fever
Ix for febrile convulsion
Only if complex seizure
