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You are contacted to respond to a "seizure" call.

Take it from here.

Take care,

chbare.

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You are contacted to respond to a "seizure" call.

Take it from here.

Take care,

chbare.

Well, let's get in the ambulance first ;) When we get to the scene, how old is the patient, what exactly happened, did anyone witness the seizure, is there a history of them and how long did it last?

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You respond to a suburban area of town and are asked to take a look at a 4 week old infant. The parents state the patient "just had a seizure." No one is sure how long it lasted exactly, the parents deny any problems or history. The house appears safe and in good repair.

Take care,

chbare.

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Is patient currently seizing, breathing?

What is skin color especially around lips, eyes, fingernail beds?

What is skin temp?

How many layers of clothes and blankets is patient wrapped in?

Does child have a fever?

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No seizure activity is noted, the patient is breathing around 40-44 times a minute with periods of irregular respiration noted, skin is pale and cool, Rectal Temp is 37 C, patient is covered with one layer of clothing.

Take care,

chbare.

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Based on the presentation stated above I would assess ABC's (that how I start on every patient regardless of CC) manage airway if indicated. I would also put the patient on O2. Since we have the fancy shmancy monitors that digitally monitor ETCO2 with NC. I would put them on that and see what readings we get. ECG.d-stick.Attempt IV access so I can unload benzos if needed. Monitor and reassess. So now what I would like to know is this

Rate and Rhythm

ETCO2

Glucose mg/dL

SpO2

No necessarily in that order. Also I had a brain fart is there any PHx?

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What did the seizure look like? Full tonic-clonic activity or something else?

Has the baby been sick at all, any underlying medical conditions that we need to know about? Any signs of trauma?

Any other children to these parents with any health conditions? Was the birth uneventful (thinking if vac was used to assist delivery maybe just maybe something happened, it's a stretch but hey...)

As others have said, vitals, blood sugar...how is the baby responding right now? Awake? Is he/she acting normally per the parents?

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I also meant to ask what do the pupils look like?

Any signs of trauma?

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The parents state the patient has had a 24-48 hour history of lethargy and "not eating well." Patient was born at home and had no medical care, mother had no prenatal care as well. Parents state there were no problems with the delivery.

The patient is very lethargic and responds with a weak cry to tactile stimuli. Blood sugar is WNL for age. No other history is noted. Sidestream ETCo2 is 17-20. You note sinus tachycardia at 130-140 on the monitor regular rhythm. Left pupil is dilated and non reactive at 5 mm, right pupil is 3 mm and reactive. No specific findings of trauma are noted; however, the anterior fontanelle is firm and bulging slightly.

Take care,

chbare.

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The parents state the patient has had a 24-48 hour history of lethargy and "not eating well." Patient was born at home and had no medical care, mother had no prenatal care as well. Parents state there were no problems with the delivery.

The patient is very lethargic and responds with a weak cry to tactile stimuli. Blood sugar is WNL for age. No other history is noted. Sidestream ETCo2 is 17-20. You note sinus tachycardia at 130-140 on the monitor regular rhythm. Left pupil is dilated and non reactive at 5 mm, right pupil is 3 mm and reactive. No specific findings of trauma are noted; however, the anterior fontanelle is firm and bulging slightly.

Take care,

chbare.

Alright this little fella/lady could potentially be in serious trouble. Bulging fontanelle = increased ICP, and since mom had no prenatal care and baby has had no medical care, opens up a list of possibilities for complications (hydrocephaly, ventriculomegaly are tops right now...)

IV access, if we can get a BP good let's do it...supplemental O2, may actually consider intubation to protect the airway if we want to get really agressive here...

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