The fitting child Flashcards
Causes of convulsions
Febrile Electrolyte imbalance->hyponatremia, hypocalcemia Drug ingestion Head injury Hypoglycemia Meningitis Asphyxial injury Epilepsy
Important history/assessment
Any compromise to ABC
Has this happened before- may have diagnosis of epilepsy already-> ?compliance
Description of the event
Duration-> >20 minutes unlikely to suffer long term brain damage
Was the child unwell/pyrexial beforehand->febrile/CNS infection
Is the child developmentally normal
Is drug ingestion/poisoning a possibility
Significant past history->VP shunt, renal/liver, endocrinopathies
Focal features
Any previous anticonvulsant
Evidence of others requiring acute management->hypoG, electrolyte imbalance, meningitis, drug overdose, trauma, stroke
Why is it important to know if child is developmentally normal
Non-febrile convulsions are more common in those with learning disability or cerebral palsy
Important examination
Ensure open airway Generalised, focal Vitals> be sure to check temperature Any obvious focus of infections Signs of trauma/head injury Examine the eyes->flicking, rolling in head Look for evidence of meningitis Check the pupils
Management of convulsions
- Supportive management 5-10 minutes
- Support airway and breathing, apply oxygen by mask, monitor.
- Secure IV access, check bedside BSL and send urgent specimen for calcium / electrolytes and venous blood gas. If hypoglycaemia present-> correct the low sugar.
- Give benzodiazepine->rectal diazepam (0.1-0.3mg/kg) or buccal midazolam (0.3 mg/kg) if no IV, give IV/IO if available
- Repeat benzodiazepine after 5 minutes of continuing seizures.
- If convulsion continues for a further 5 - 10 minutes, commence IV phenytoin or phenobarbitone. If IV access cannot be secured and seizures refractory to benzodiazepines, consider IO access.
- Consider pyridoxine (100mg IV) in young infants with seizures refractory to standard anticonvulsants.
- Seek senior assistance if seizure not controlled. Anticipate need to support respiration. Thiopentone or Propofol and rapid sequence induction (RSI) may be required for seizure control.
Be sure to correct any metabolic abnormalities/hypoglycemia
Advice to parents to manage a major seizure at home
Stay calm Check medical identification Protect from injury, move objects away Time the seizure/video Loosen anything tight around neck Put something soft under head Stay with child reassure then Do not put anything in their mouth Do not restrain them When seizure is over roll onto side Consider if need an ambulance Try to give privacy away from others
Advice to parents to manage minor seizure at home
Stay calm Check medical IS Gently guide away from harm Time/record Stay with child and reassure them Try to give privacy
How to manage if in a stroller, car seat or wheelchair
leave the child seated if they are secure and safely strapped in
gently hold their head
when the jerking stops, if they are unconscious, take them out of the seat, lay them down and roll them onto their side
When to call an ambulance
You should call an ambulance if:
you think it is the child’s first seizure
the seizure lasts more that five minutes
another seizure quickly follows the first one
the child remains unconscious or has trouble breathing after the seizure
the seizure happens in water
the child is hurt or injured
the child has diabetes
the child does not seem to fully recover
you are about to give medications to stop the seizure. For example diazepam or midazolam
When is the greatest risk for having another seizure
Within three months of having the first one
Parent safety recommendations after a first seizure
- Develop action plan with GP
- Medical ID bracelet
- Child always swims with adult (also needs to be able to swim well)
- Showers instead of bath
- Turn cold water on first, lower hot water temperature of service
- Special care when using hot things that may cause burns
- Make sure other carers know about the childs epilepsy and can manage appropriately
- Avoid activities at height unless appropriate supprot
- Make sure car/home has first aid kit
Side effects of carbamazepine
Drowsiness, headache, unsteadiness, dizziness, n/v,
skin rash, agranulocytosis/aplastic anemia (rare)
Side effects of valproate
Hepatic failure, headache, somnolence, alopecia,
n/v, diarrhea, tremor, diplopia, thrombocytopenia,
hypothermia, pancreatitis, encephalopathy
Investigations
Blood glucose
UEC, CMP
LP if suspect meningitis, beware +ICP
CT/MRI if head trauma, focal neurological signs
Blood/urine/throat/CXR to look for focus of infection
Urine toxicology if drug ingestion/overdose
