Febrile convulsions + pulse Oximetry Flashcards
What is febrile convulsion?
Febrile seizures are convulsions that can happen when a young child has a fever above 100.4°F (38°C). (Febrile means “feverish.”) The seizures usually last for a few minutes and stop on their own. The fever may continue for some time
Febrile convulsions can be secondary to…..
viral infection
When does febrile convulsions typically occur?
6 month- 5 year olds
but mainly 12-16 months
What are the causes of febrile convulsion?
1) Viral infections (influenza, HHP roseola)
2) Other infections (otitis media, tonsullitis, hastroenterisits)
3) Post immunisation- rare
RF for febril convulsion?
- more likely in those with family history of febrile convulsions
- more likely in the peak age range
- more likely in those where the temperature has wuickly increased and high grade temperatures
Why does fever cause febrile convulsions in children?
1) increased excitatory neuron stimulation
2) increased cytokines and IL in the blood
3) feber causes hypervemtilation- causes respiratory alkalosis? Reduced convulsions
What is different about fever in children?
Children have..
a) more labile temperature
b) immature thrrmoregulation- more likely to spike high grade temperatires
c) More likely to have sudden increses in temperature? increased likelihood of febrile convulsion
What is the patho of convulsions?
- multiple meurons are excited or stimulated in synchrony
- at this excitatory synapse, glutamate is released (the excitatory neurotransmitter)
- This causes an influx of Na and Ca into the cells. These are both positively charged ions
- This triggers an action potential
What is the difference between simple and complex seizure?
pattern ?
Duration?
Occurrence in 24 hours
Neurological statue?
History of febrile convulsion?
How do you febrile convulsions?
Short
self-resolving
no post-ictal phase
tonic clonic
No residual neurological deficit
preceding viral illness
can have fever after the episode
most are simple febrile convulsions
What is Tx for febrile convulsiosn?
NO treatment usually needed
usually self resolving
If someone comes in with complex seizures, what are the Ix you would do?
may want to rule out other causes- bloods/lumbar puncture/EEG/ Neuro-imaging
If seizures are pro longed you could consider….
benzodiazepine
is prognosis good in febrile convulsions
yes
Do anti pyretics reduce seizure frequency
No
What is an oximeter measuring?
Non invasive measuremrnt of blood oxygen saturation
What is pulse plethysmography?
Wave form of change in volume of arterial blood with each oulse beat
records quality of signal, irregular heart rates and respiration
3 facts to know about oxygen sat curve
- Sigmoidal. When oxygen saturation is >90% increases in Po2, have little effect on saturations
When Pa02 is <8kPa or 60 mmHg then may be dramatic effect on saturation
- Increase PO2 by increase HR//RR or giving additional 02
- Curve rught and left (towards right, less binding, mmore tissues)
Limitation to oximeter
- Moveemtn artefact - wriggly toddlers
- Reduced signal if hypoperfused/cold
- Skin colour/nail varnish
- false results- abnormal Hb or sever anaemia. Carbon monoxide poisoning (both oxy and Cohb have similar absorptions- false normal
Would you use a home oximeter on a child who had home oxygen all time?
No- because theyw ould have been assesed before they went home
Would you a home oximeter on child with ALTE/BRUE
ALTE- Acute (apparent) life threatening events
BRUE- Brief, resolved, unexplained event
No
Would you give a child with central apneoea a home oximeter
yes
WHat are the pros and cons of home oximeter?
