Interesting Case Rounds
Jennifer Nicol PGY-2July 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 38.5RR 31
HR 192BP 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 resultsLP: 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
15-29minpartial / 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?