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

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?