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An Evidence-Based Approach To Pediatric Seizures In The Emergency Department - $30.00
This issue includes 4 AMA/ACEP category 1, AAP Prescribed CME credits
Authors:
Christopher D. Berg, DO, FAAEM,
Heather Schumann, PharmD
Peer Reviewers:
Martin I. Herman, MD,
Paula J. Whiteman, MD, FACEP, FAAP
Publication Date:
February 1, 2009, Volume 6, Number 2
Excerpt from the issue…
An 11-month-old baby is rushed back to a room in your emergency department, carried by his mother. The baby appears to be having a prolonged generalized seizure. His parents are frantic they have never seen him act like this before. Checking his airway is your first concern, and you scramble for the suction and the pediatric ambu-bag. The resident working with you looks like a deer in headlights this is his first encounter with a seizing infant. The nurses look to you, the attending physician, for direction as they struggle with the baby’s arm for IV access. You, an avid reader of evidence-based medicine regarding the management of pediatric seizures, know exactly what to do to help this baby.
Conclusion to the above case study...
The 11-month-old boy that arrived seizing presents several challenges: first, you need to be sure that the child is breathing and oxygenating adequately. Next, you need to establish an IV line.
Soon after, the boy stops seizing and is breathing easily but remains lethargic. You note on your secondary assessment that he has no signs of trauma and a fever of 104°F. You administer rectal acetaminophen. You obtain appropriate laboratory work, such as a bedside glucose and serum electrolytes. In this case, you also obtain a CBC and urine analysis as well as blood and urine culture, as there is no obvious source for his fever. As this lethargic boy is less than 12 months of age, the appropriate IV antibiotics are initiated without delay. You even remember to give a dose of dexamethasone with your antibiotics, especially important as the child’s immunizations against H. Influenza are not up to date.127 You then perform the lumbar puncture, which comes back positive for 100 wbcs, with a predominance of lymphocytes and has a negative gram stain.
You are relieved. You have not only treated a febrile seizure, you have also diagnosed the boy’s meningitis in a timely manner. You managed this case as if it were a serious, bacterial meningitis causing his seizure, but fortunately it was only viral meningitis. The boy is admitted and does well. Eventually, his spinal fluid cultures are negative, and he goes home without further complications.
About this article:
It is important for the ED physician to know the many possible causes of seizures and to be comfortable treating seizures in neonates and children in order to provide the best possible standard of care for such patients when they present to the ED.
