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CASE HISTORY
Case History
4 year old girl brought by ambulance following a prolonged seizure, which had begun 40 minutes earlier. Parents found her in the living room shaking all of her body and unresponsive to their voices. Immediately called 999 ambulance. The paramedic team have given diazepam rectally and she is on 100% oxygen.
Non-specifically unwell for several days with a cold and behaving quite irritably. Fever for 24 hours and vomited during the day - her parents have been giving her paracetamol. She has never had fits before and there is no family history of seizures.
Taken immediately to ED Resuscitation: Status epilepticus ? cause possible infection. ED SHO assessment immediately:
Airway self-maintained but guedel airway in situ inserted by paramedics. 100% oxygen with saturations of 100%. Air entry equal bilaterally. Well-perfused centrally.
Generalised tonic clonic seizure continuing. No rashes seen.
Observations: Temp 39.5, BP 130/80 (difficult to measure), Pulse 100, RR 56.
Blood sugar 7.1.
Immediate intervention
i.v. access obtained X 2, bloods taken including blood cultures.
i.v. ceftriaxone and acyclovir commenced
Given IV lorazepam X 2 0.1mg/kg, failed to stop seizure
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QUESTIONS ON CASE 9
Q 2 of 8: Are further clinical observations necessary?
YesNo
INCORRECT
: Observe pupil size and reaction, peripheral perfusion. Once the fitting has stopped the patient should have blood pressure repeated, fundoscopy, and examination for neck stiffness. Continue to watch for the appearance of a rash.
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Further Information
Initial assessment of any febrile child
For all febrile children the following should be undertaken:
The following clinical signs must be measured and recorded to complete a full assessment:
Full-blown non-blanching haemorrhagic rash*
Age
| HR/min
| RR/min
| Systolic BP
|
<1 |
110-160 |
30-40 |
70-90 |
1-2 |
100-150 |
25-35 |
80-95 |
2-5 |
95-140 |
25-30 |
80-100 |
5-12 |
80-120 |
20-25 |
90-110 |
Over 12 |
60-100 |
15-20 |
100-120 |
From Advanced Paediatric Life Support—the Practical Approach. 30
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