Acute onset, seizure activity

Treatment

• Scene – IV, O2, EKG, Versed (midazolam), CBG

• En route – 02, supportive care assessment

• Hospital – after about 20 min., Ativan was given – unknown dose

Disposition

• Response to treatment – pt responded very quickly to Versed and 02 on scene; seizure stopped within about a minute.

• Disposition – pt remained with altered LOC and had a gaze to right side, shaking stopped.

Authors:

• Mark Shelton Paramedic Woodburn Ambulance

Editors:

• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

Diagnosis

• Cerebrovascular accident (CVA)
• Seizure

Differential Diagnosis

• Seizure vs. status epilepticus

• Aspiration

• Trauma

• Ascertain etiology for seizure (poor sleep, infectious process).

• Poor compliance with anti-epileptic medications.

• Metabolic (electrolyte imbalance associated with diarrhea, if present).

Patient Workup History

• Patient states – Patient did not speak to us at all.

• Caregivers (mom and dad) state – Patient has one seizure a year, typically at this time of the year. Patient had a stroke in utero and has some slight right sided deficits, but per Mom you can hardly tell. Patient is able to talk and function normally.

Physical Exam

• GCS 4/1/1

• Sat – 88% on pt contact and 100% with 02

• CBG – 123

• ALOC; in active seizure upon arriving

• Aspiration sounds noted

• Right-sided gaze to both eyes; right arm shaking.

• Both legs also had shaking, but to a lesser degree; left arm was held by medics easily and no signs of extension or flexion.

Editor’s Notes

Sometimes it can be difficult to ascertain whether a child is actively seizing or in a postictal state. The eye deviation is certainly concerning for active seizure. Oftentimes in the ED or PICU settings, to make this determination of seizure status the child may need active EEG monitoring. The medics in this case did a great job of securing an IV, delivering a benzodiazepine (Versed), and monitoring vitals and clinical status. Video before and after was a useful tool to determine change in mental status, which is “altered”.

-David Spiro, MD