Focused Seizure History
In the previous step we saw poor Oscar being assessed by the paramedics. Let’s look at what you should focus on when presented with a fitting child.
Focused Seizure History
1. How long has the seizure being going on for?
• The longer the seizure goes on for, the more likely permanent injury is to happen.
• Medication should be given if the seizure >5mins and consideration of second dose if seizures haven’t stopped after a further 10 mins after first medication dose given.
2. Is the child known to have seizures?
• Parents generally have a good understanding of their child’s seizure history and will quickly recognise any abnormal patterns or worrying features.
• Children with known epilepsy can have specific seizure patterns. Important to get this history from parents who will normally know. They may have a specific management plan which deviates from normal APLS/JRCALC guidelines.
Important to identify to establish correct management pathway early
• What medications are they on? Have they had any emergency medications prior to arrival?
• Important to know what the child has had prior to your arrival if on a seizure plan, so as to give further medication at the correct time and not overdose the child.
Possible Causes of Seizures
1. Does the child have a temperature?
• Febrile convulsions are the commonest cause of seizures in children without diagnosed epilepsy between the age of 6 months to 6 years. They are normally associated with a significant change in temperature and are normally self resolving and short lived <5mins.
• If the child has a temperature and the seizure continues, sepsis especially meningitis should be considered.
2. Has the child had a head injury?
• If the child has had a recent (last 24 hours) head injury then the cause of the seizure may be related to brain injury or intercranial bleeding. Consider trauma as a cause.
Diazepam Side Effects
1. Respiratory depression.
• Important to do full assessment of breathing when giving anticonvulsant medication. This is especially important if more than 1 dose or an IV dose has been given.
• If child has shallow respirations, or slow respirations it is important to recognise this to be able to support their breathing with adjuncts or a bag valve mask device.
2. Drowsiness, confusion & unsteadiness.
• This is important to be aware of, but could also be caused by the post ictal (post fit) phase of the seizure.
• Important for the safe transfer of the child as a reduced GCS may indicate the need for airway support.
• Consider if these symptoms are caused by ongoing subclinical seizures.
• Important to look and review the child and their eyes which may be the only sign of ongoing seizures (e.g. deviation to one side).