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Interesting Case Rounds

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. > 3 0 minutes 5 mg IM midazolam with EMS. PERL 3, no deviation No cry, no eye opening, no purposeful movements

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Interesting Case Rounds

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  1. Interesting Case Rounds Jennifer Nicol PGY-2 July 26, 2010

  2. STAT to trauma Bay! • 21 month female actively seizing • Previously well • Temp last night 38.2 • >30 minutes • 5 mg IM midazolam with EMS

  3. PERL 3, no deviation No cry, no eye opening, no purposeful movements Hypertonic, frequent tonic convulsions First Priority?

  4. Temp 38.5 RR 31 HR 192 BP 128/88 Sa02 99 NRB BG 3.6

  5. Lorazepam 0.2mg/kg x 2 0.1mg/kg x 3 Phenytoin load 20mg/kg Cefrtiaxone PR acetaminophen

  6. Induction with benzos – midazolam 2mg Atropine Succinylcholine Cap gas 7.27/40/18.4 lactate 2

  7. No significant past medical history OM x 2, last May 2010-ABx Fever, runny nose in afternoon No trauma, toxins

  8. Thoughts, Doctor?

  9. Bloodwork unremarkable Urinalysis normal

  10. Pan culture no growth

  11. Ooops!

  12. LP: cell count, gram stain normal, cultures negative LP results

  13. EEG: normal, some central spikes

  14. Cefotaxime, Vancomycin, Acyclovir Extubated next day Admitted for 4 days Recurrent fevers, no seizures Diagnosis: “febrile tonic-clonic generalised status epilepticus”

  15. Febrile Seizure • Simple • Complex • Febrile status epilepticus

  16. Complex febrile Seizure 15-29min partial / focal >1episode without recovery

  17. Febrile Status Epilepticus • >30min • + Definition simple febrile seizure • can include developmentally abnormal

  18. No short term morbidity or mortality Significantly increased febrile seizures in developmentally delayed children, <1yr ? Risk of mesotemporal lobe scarring/epilepsy ?

  19. Future Risk Epilepsy Baseline 1% Simple FS 2-3% Complex FS 5-10% Febrile SE ?>5-10%

  20. Questions?

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