Post-ictal State, S/P Seizure Event part 2


• Transported for evaluation


• Unknown


Elliot Williams, Paramedic Woodburn Ambulance

David Sheridan, MD Associate Professor Oregon Health and Science University


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

Craig Warden, MD Professor Oregon Health & Science University


• Postictal state
• Febrile seizure

Differential Diagnosis

• Febrile seizure

• Postictal state

• Closed head injury (concussion, intracranial bleed)

• Infection (eg, meningitis)

• Metabolic causes (diabetic ketoacidosis)

• Accidental trauma

• Non-accidental trauma Patient Workup

• History

• Physical exam

• Vitals obtained but not available

Editor’s Notes

Note that the child cries and then becomes quiet. At times the child seems to have an altered mental state – cycles of crying and then staring. This may be seizure activity or just simply part of the postictal state. Febrile seizure is a common indication for pediatric EMS calls. If the patient has stopped seizing spontaneously and appears to be improving, an IV is not necessary. Midazolam has great activity given IN, buccal or IM.

-David Spiro, MD

Standard Approach

First steps

• The first step is to ensure that a child with seizure activity is maintaining his or her airway. Once this is ensured, further measures can be taken.

• Establishing IV access is important not only for medications to stop the seizure, but also to administer glucose, if needed, as hypoglycemia is a common cause of seizures in young children.

• Checking a bedside glucose is vital information for prehospital care as well as for care in the emergency department. • Note that a febrile seizure may be the first indication the child is ill.

• Febrile seizures in children should last less than 5 minutes, but can last as long as 15 minutes and still be considered a simple febrile seizure. As this child demonstrates, a postictal period follows. The suggested prehospital approach includes:

• Establish an airway: if patient is maintaining, ensure adequate respirations and saturations. The best way to manage the airway is to stop any ongoing seizures.

• Establish IV access if seizing on arrival, but give first dose of benzodiazepine IN or IM, or rectally if using diazepam.

• Check a bedside glucose

• First-line treatment for persistent seizure activity is a benzodiazepine. This may be repeated if continued seizure activity for 5 minutes after administration.

Suggested References

Febrile seizures

Pediatric febrile seizure


• Gender: Female

• Age: 9 months

• Height: Not Available

• Weight: Not Available


• Temperature: 101.4 F/38.6 C

• Blood Pressure: Not Available

• Heart Rate: Not Available

• Respiratory Rate: Not Available

• Pulse Oximetry: Not Available

Signs and Symptoms

Sudden-onset fever; several minutes of quiet shaking, followed by reduced responsiveness.

History Medical

• No previous seizure history

• No medications

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