Interesting Case Rounds Jennifer Nicol PGY-2 July 26, 2010.
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Transcript of Interesting Case Rounds Jennifer Nicol PGY-2 July 26, 2010.
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Interesting Case Rounds
Jennifer Nicol PGY-2July 26, 2010
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STAT to trauma Bay!• 21 month female
actively seizing
• Previously well• Temp last night 38.2
• > 30 minutes• 5 mg IM midazolam
with EMS
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PERL 3, no deviation
No cry, no eye opening, no purposeful movements
Hypertonic, frequent tonic convulsions
First Priority?
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Temp 38.5RR 31
HR 192BP 128/88
Sa02 99 NRB
BG 3.6
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Lorazepam 0.2mg/kg x 2 0.1mg/kg x 3
Phenytoin load 20mg/kg
Cefrtiaxone
PR acetaminophen
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Induction with benzos – midazolam 2mg
Atropine
Succinylcholine
Cap gas 7.27/40/18.4 lactate 2
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No significant past medical history
OM x 2, last May 2010-ABx
Fever, runny nose in afternoon
No trauma, toxins
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Thoughts, Doctor?
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Bloodwork unremarkable
Urinalysis normal
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Pan culture no growth
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Ooops!
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LP resultsLP: cell count, gram stain normal, cultures negative
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EEG: normal, some central spikes
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Cefotaxime, Vancomycin, Acyclovir
Extubated next day
Admitted for 4 days
Recurrent fevers, no seizures
Diagnosis: “febrile tonic-clonic generalised status epilepticus”
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Febrile Seizure• Simple• Complex–Febrile status
epilepticus
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Complex febrile Seizure
15-29minpartial / focal>1episode without recovery
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Febrile Status Epilepticus
• >30min• + Definition simple febrile seizure• can include developmentally
abnormal
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No short term morbidity or mortality
Significantly increased febrile seizures in developmentally delayed children, <1yr
? Risk of mesotemporal lobe scarring/epilepsy ?
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Future Risk Epilepsy
Baseline 1%Simple FS 2-3%Complex FS 5-10%Febrile SE ?>5-10%
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Questions?