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Had Become Limp And Unresponsive. Took Paracetamol. What Are The Findings And Required Treatment?
2 year old boy fitting. limp child wrapped in a blanket who is making some attempts to cry.
Airway: Clear
Breathing: 32
Circulation: HR via apex beat = 164, extremities warm and flushed.
Disability: V = Crying M = purposeful movement - pushing your hand away. E = 3. Pupils equal and reactive to light.
It is a warm summer day and the child's tympanic temperature is 39.9 degrees C.
The mother tells you that the child has been unwell since yesterday, has been refusing all food and most fluids. The child had been given paracetamol to settle last night with moderate effect. She has not taken the child's temperature this morning. The child was restless, irritable and not wanting to be comforted by her just prior to the seizure occurring. She described a generalised seizure lasting approximately one minute, then the child became limp and unresponsive. The mother reports that the child began to move and cry a little after the episode. She did think that the child had stopped breathing for a little while but didn't think that he was blue at all. The child had not been incontinent. There were no apparent injuries to the mouth, teeth or limbs.
Allergies - Nil known
Medications - paracetamol last night
PMHx - Nil significant. Fever when teething.
On further examination - Chest clear, abdomen soft, non-tender, pain with pressure over L) tregus. Child is becoming more alert and telling you "No" to your attempts to examine him.
Airway: Clear
Breathing: 32
Circulation: HR via apex beat = 164, extremities warm and flushed.
Disability: V = Crying M = purposeful movement - pushing your hand away. E = 3. Pupils equal and reactive to light.
It is a warm summer day and the child's tympanic temperature is 39.9 degrees C.
The mother tells you that the child has been unwell since yesterday, has been refusing all food and most fluids. The child had been given paracetamol to settle last night with moderate effect. She has not taken the child's temperature this morning. The child was restless, irritable and not wanting to be comforted by her just prior to the seizure occurring. She described a generalised seizure lasting approximately one minute, then the child became limp and unresponsive. The mother reports that the child began to move and cry a little after the episode. She did think that the child had stopped breathing for a little while but didn't think that he was blue at all. The child had not been incontinent. There were no apparent injuries to the mouth, teeth or limbs.
Allergies - Nil known
Medications - paracetamol last night
PMHx - Nil significant. Fever when teething.
On further examination - Chest clear, abdomen soft, non-tender, pain with pressure over L) tregus. Child is becoming more alert and telling you "No" to your attempts to examine him.
Fri, 26 Apr 2013
This looks like a febrile seizure without an underlying condition. But this kid should be taken to an emergency hospital as soon as possible, because I can't rule out serious conditions based on this story alone. Although this is probably benign. Take this kid to a hospital right away, it is an emergency.
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