11/8/1

OBJECTIVES

• PLAN FOR EMERGENCIES

NEUROLOGICAL • INITIAL SEIZURE ASSESSMENT AND MANAGEMENT

EMERGENCIES • RECOGNISE TYPES OF FEBRILE CONVULSIONS AND THEIR MANAGEMENT

• ASSESSMENT OF HEAD INJURY PATIENT

MALAZ ELSADDIG
ST2 PAEDS

PREPARATION IS

• 4 YR M • TEAM
• CONTINUOUS FITTING • EQUIPMENT

• RR 28, SAT 97% ON O2 • DRUGS

• HR 150, BP110/67 • MORE INFORMATION

• ETA 3 MINS

WETFLAG BACK TO OUR PATIENT…

• WEIGHT = (AGE + 4)X2 • W= 16KG

• ENERGY = 4 J/KG ASYNCHRONOUS SHOCK • E= 60J

• TUBE = (AGE/4) + 4 +/- 0.5 • T= 4.5, 5, 5.5

• FLUIDS = 20 ML/KG 0.9% NACL • F= 320 ML OF 0.9% NACL

• LORAZEPAM = 0.1MG/KG • L= 1.6MG

• ADRENALINE = 10 MICROGRAM/KG (0.1ML/KG OF 1:10,000) • A= 1.6ML OF 1 IN 10,000 ADRENALINE

• GLUCOSE = DEXTROSE 10% 2ML/KG • G= 32ML OF 10% GLUCOSE
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PARAMEDICS HANDOVER… WHAT’S NEXT?

• LESS ACTIVE PREVIOUS DAY, TEMP 38.4 • A:

• TODAY LESS ACTIVE AGAIN, ↓ FEEDING , TEMP 39.6

• B:
• JERKING OF BOTH ARMS AND LEGS, ERRATIC BREATHING, EYES MOVING IN ALL
DIRECTIONS.
• C:
• IT STARTED 4MINS AGO

• D:

• E:

FEBRILE CONVULSIONS

DEFINITION EPIDEMIOLOGY

“FEBRILE CONVULSIONS ARE SEIZURES (FITS OR CONVULSIONS) OCCURRING IN • BETWEEN 2% AND 5% OF EUROPEAN CHILDREN HAVE A FEBRILE CONVULSION
CHILDREN AGED 6 MONTHS TO 5 YEARS, ASSOCIATED WITH FEVER, WITHOUT
• 6 MONTHS AND 5 YEARS OF AGE
OTHER UNDERLYING CAUSE SUCH AS CNS INFECTION OR ELECTROLYTE
• THE MEDIAN AGE OF ONSET IS 18 MONTHS
IMBALANCE”
• 24% HAVE A FAMILY HISTORY OF FEBRILE SEIZURES

• 4% HAVE A FAMILY HISTORY OF EPILEPSY

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ASSESSMENT
HISTORY
• EYEWITNESS ACCOUNT OF THE SEIZURE
• ESTABLISH WHETHER IT WAS A FEBRILE SEIZURE
• SYMPTOMS OF MENINGITIS OR SEPTICAEMIA
• PAST/FAMILY HISTORY OF FEBRILE SEIZURE OR EPILEPSY

EXAMINATION
• VITAL SIGNS
• CONSCIOUS LEVEL
• RASH (BLANCHING OR NON-BLANCHING)
• FONTANELLE
• MENINGISM
• LOOK FOR FOCUS OF INFECTION.

CAUSES OTHER DIAGNOSIS

• VIRAL INFECTIONS • RIGORS

• OTITIS MEDIA
• SYNCOPE
• TONSILLITIS
• BREATH-HOLDING SPELLS
• GASTROENTERITIS
• REFLEX ANOXIC SEIZURES
• POST-IMMUNISATION
• MENINGITIS AND SEPTICAEMIA • APNOEA

• UTI • OTHER CAUSE OF SEIZURES - E.G.: EPILEPSY, HEAD

• LRTI INJURY, ENCEPHALITIS, HYPOGLYCAEMIA, HYPOCALCAEMIA, POISONING

• CEREBRAL MALARIA • POSTICTAL FEVER

CLASSIFICATION Management

• SIMPLE FEBRILE SEIZURES

• THESE ARE GENERALISED, TONIC-CLONIC SEIZURES LASTING <15 MINUTES, WHICH Home Observe Admit
DO NOT RECUR WITHIN 24 HOURS OR WITHIN THE SAME FEBRILE ILLNESS.

• COMPLEX FEBRILE SEIZURES

• Well child • Drowsy before seizure
• FOCAL FEATURES AT ONSET OR DURING THE SEIZURE. • Identifiable focus • <18 months • GCS <15 at one hour
• DURATION OF MORE THAN 15 MINUTES. • Complex seizure
of infection after seizure
• Parents understand • The child has had • Neck stiffness
• RECURRENCE WITHIN THE SAME FEBRILE ILLNESS. antibiotics
how to treat febrile • Petechial (non-
• FEBRILE STATUS EPILEPTICUS • No focus of
illness and further blanching) rash
seizures infection is found • Bulging fontanelle
• THIS IS A FEBRILE SEIZURE LASTING FOR LONGER THAN 30 MINUTES.
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INVESTIGATIONS WHEN TO LP?

Features LP?
• BLOOD TESTS: FBC, ESR, GLUCOSE, U&E, COAGULATION, CULTURE.
Age <18 months Consider
• URINE MICROSCOPY/CULTURE IF: AGE <18 MONTHS, COMPLEX SEIZURE OR NO
FOCUS OF INFECTION FOUND. Simple febrile seizure, otherwise normal No

• LUMBAR PUNCTURE TO BE CONSIDERED Febrile status epilepticus Yes

Complex febrile seizure, otherwise normal Consider

Neurodevelopmental abnormality and complex No

febrile seizure
Symptoms and signs suggestive of meningitis Yes

DISCHARGE

• INFORM PARENTS ABOUT THE NATURE OF FEBRILE SEIZURES

• ADVISE PARENTS ON WHAT TO DO IF A FURTHER SEIZURE OCCURS

• ADVISE PARENTS ABOUT MANAGING FEVER

• ADVISE PARENTS TO CONTINUE CHILDHOOD IMMUNISATIONS

• DO NOT PRESCRIBE DRUGS TO MANAGE OR PREVENT FUTURE SEIZURES UNLESS

ADVISED TO DO SO BY A SPECIALIST

• ARRANGE FOLLOW-UP

HEAD INJURY
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ED ASSESSMENT
HISTORY
• MECHANISM OF INJURY
• TIMING
• RED FLAGS
• OTHER INJURIES
• SAFEGUARDING CONCERNS

EXAMINATION
• VITAL SIGNS
• CONSCIOUS LEVEL
• NEUROLOGICAL DEFICIT
• PUPILS & CONJUNCTIVA
• BRUISES, LACERATIONS, FRACTURES

SUMMARY
• HOW TO PLAN FOR INCOMING EMERGENCY

• USING WETFLAG TO CALCULATE EMERGENCY

DOSING

• INITIAL MANAGEMENT OF SEIZURES

• RECOGNISE FEBRILE CONVULSIONS AND THEIR
CLASSIFICATIONS

• ASSESSMENT AND INVESTIGATIONS FOR HEAD

INJURIES

THANK YOU
QUESTIONS?

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