Interesting Case Rounds Jennifer Nicol PGY-2 July 26, 2010
STAT to trauma Bay! 21 month female actively seizing Previously well Temp last night 38.2 > 30 minutes 5 mg IM midazolam with EMS
PERL 3, no deviation No cry, no eye opening, no purposeful movements Hypertonic, frequent tonic convulsions First Priority?
Temp 38.5 RR 31 HR 192 BP 128/88 Sa02 99 NRB BG 3.6
Lorazepam 0.2mg/kg x 2 0.1mg/kg x 3 Phenytoin load 20mg/kg Cefrtiaxone PR acetaminophen
Induction with benzos – midazolam 2mg Atropine Succinylcholine Cap gas 7.27/40/18.4 lactate 2
No significant past medical history OM x 2, last May 2010-ABx Fever, runny nose in afternoon No trauma, toxins
Thoughts, Doctor?
Bloodwork unremarkable Urinalysis normal
Pan culture no growth
Ooops!
LP results LP: cell count, gram stain normal, cultures negative
EEG: normal, some central spikes
Cefotaxime, Vancomycin, Acyclovir Extubated next day Admitted for 4 days Recurrent fevers, no seizures Diagnosis: “febrile tonic-clonic generalised status epilepticus”
Febrile Seizure Simple Complex – Febrile status epilepticus
Complex febrile Seizure 15-29min partial / focal >1episode without recovery
Febrile Status Epilepticus >30min + Definition simple febrile seizure can include developmentally abnormal
No short term morbidity or mortality Significantly increased febrile seizures in developmentally delayed children, <1yr ? Risk of mesotemporal lobe scarring/epilepsy ?
Future Risk Epilepsy Baseline 1% Simple FS 2-3% Complex FS 5-10% Febrile SE ?>5-10%
Questions?