THE FITTING CHILD

Question 1

What is must always be checked in a fitting child? This can be done at the bedside

Answer 1

Glucose

Question 2

What are the 6 main investigations to be carried out in a fitting child, explain their significance?

Answer 2

• Glucose: every child
• Urea + electrolytes, calcium, magnesium: hyponatraemia, hypercalcaemia, hypermagnesaemia can cause fits
• Lumbar puncture: suspected meningitis
• MRI: history of trauma or neurological signs suggesting intracranial lesion
• Blood + urine cultures, throat swab, CXR: look for focus of infection
• Urine toxicology: if drug ingestion or overdose suspected

Question 3

Why is lumbar puncture contraindicated in raised intracranial pressure?

Answer 3

• As space-occupying lesion grows, ICP rises
• When LP performed a low-pressure shunt forms at site of LP where CSF can escape
• As CSF pressure drops, CSF and brain mass shifts towards low-pressure outlet

→ May lead to transtentorial or uncal herniation and acute neurological deterioration

Question 4

What is a febrile convulsion? What are the two different types?

Answer 4

Convulsion occurring in children between ages of six months of five years and triggered by fever, usually part of URTI.

Can be simple (75%) or complex convulsions

Question 5

How do you treat febrile seizures?

Answer 5

• Identifying and treating source of fever
• Cool child by undressing them and sponging with tepid water
• Paracetamol or ibuprofen

Question 6

If available what should be given to seizing child?

Answer 6

Oxygen by face mask

Question 7

How do you manage status epilepticus with IV access and no IV access?

Answer 7

• IV access: Lorazepam
• No IV access: Buccal midozalam or rectal diazepam

→ if this doesn’t work after 5 minutes, give IV or IO phenytoin (phenobarbital if already on phenytoin)

Question 8

How should children be placed when seizing?

Answer 8

Recovery position, protect airway