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chbare

Seizure?

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Im with EMT on that. regardless of cause of the increased ICP. The patient needs a neurosurgeon like a fish needs water. I know its a corny analogy but its early for me.

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Backtrack for a moment, please?

The patient has no notable fever?

Can anyone enlighten me as to how fast a fever can "break", as I want to know if the patient had any fever, while having the seizure episode, as, due to the age, I'd be thinking febrile seizure?

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XII lead shows sinus tachycardia without any conduction abnormalities.

No notable fever. Rectal temp is as noted in an earlier post.

Anything potentially stand out in the history?

Take care,

chbare.

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THe baby is not breathing WNL it shoudl be 20-40 bpm, you should get a medic and called the hospital about a neonatal trauma,espically with unequal diameter of pupils, unknown cause of siezure and get the hell out of there and on the road!!

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Ok, rapid transport sounds good. Let's say the patient continues to deteriorate while en-route to the hospital. You end up having to intubate while attempts at peripheral IV access are unsuccessful. Would you go IO for access?

Upon arrival at the ER, you find that the current economic situation seems to be effecting the supposedly recession proof physician and nursing professions. Looks like you will be managing the patient from here on out.

What do you want to do? What about the parents? Will you let them stay with the patient?

Take care,

chbare.

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Im not a medic but that would be their decision....I would have to call for a chopper to take this patient to a neonatal hospital....i would have a liason from the hospital talk to the parents telling them thier child is in very serious condition...i would let the parents stay with the pt till the chopper got to the hospital...

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Hmmm,

Do we see any odd signs with the baby? Bruises that shouldn't be there? Odd marks? What are the parents reactions to the situation? Do they seem appropriately concerned? Overly apologetic? Apathetic?

I'm thinking these guys from history may have had this baby and are feeling just a little overwhelmed and that may have resulted in some shaken baby here ! A head bleed could certainly account for the unequal pupils and bulging fontanelle. As far as treatment, I'm gonna go aggressive with this kid. I want definite IV access (if I can't get it, you better believe I'd go IO), and with isolated head injury possibly consider mannitol (even though I know it's getting pulled off more and more trucks). If kid seizes again, consider some benzos and I'm gonna be prepared to take care of the airway if needed, but I'll only tube if I have to (bag 'em if you have to, tube them only if you must). I'm not thinking febrile seizure here - wouldn't account for some things. Tell me more of what I want to know and I'll tell you what else you might get.

As far as letting mom and dad stay with the kid, I'd be hesitant, especially if I can separate them calmly. In general they probably aren't good candidates to have around with a kid going down the tubes and I prefer to keep things as calm as I can. Oh, BTW, at the hospital, if findings confirm my suspicions, I'll be having a chat with the ER doc 'cause I'm seriously believing one of the parents got overwhelmed with a new crying baby and just couldn' t make it stop, snapped, and didnt realize the damage they did until now. I've seen more than one case like this and this is reminding me too much of a run I made not long ago which fit the criteria. I could be way off here, but it's sounding mighty close.

Oh and BTW - can I add a transfer to an appropriate facility either via bird if available to fly or I'll take ground either way this baby needs a pedi neuro and it's not looking like we're gonna get it here !

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You are able to obtain IO access without incident. No "odd signs" and no specific external indications of trauma. The parents seem genuinely concerned and will try to answer any questions to the best of their abilities. Unfortunately, you are in a center with all the resources to handle this patient; however, do to budget cutbacks you will double as the ER physician or any other physician you would call for consultation today.

What do you want? What will you do?

Take care,

chbare.

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Hmmm,

Do we see any odd signs with the baby? Bruises that shouldn't be there? Odd marks? What are the parents reactions to the situation? Do they seem appropriately concerned? Overly apologetic? Apathetic?

I'm thinking these guys from history may have had this baby and are feeling just a little overwhelmed and that may have resulted in some shaken baby here ! A head bleed could certainly account for the unequal pupils and bulging fontanelle. As far as treatment, I'm gonna go aggressive with this kid. I want definite IV access (if I can't get it, you better believe I'd go IO), and with isolated head injury possibly consider mannitol (even though I know it's getting pulled off more and more trucks). If kid seizes again, consider some benzos and I'm gonna be prepared to take care of the airway if needed, but I'll only tube if I have to (bag 'em if you have to, tube them only if you must). I'm not thinking febrile seizure here - wouldn't account for some things. Tell me more of what I want to know and I'll tell you what else you might get.

As far as letting mom and dad stay with the kid, I'd be hesitant, especially if I can separate them calmly. In general they probably aren't good candidates to have around with a kid going down the tubes and I prefer to keep things as calm as I can. Oh, BTW, at the hospital, if findings confirm my suspicions, I'll be having a chat with the ER doc 'cause I'm seriously believing one of the parents got overwhelmed with a new crying baby and just couldn' t make it stop, snapped, and didnt realize the damage they did until now. I've seen more than one case like this and this is reminding me too much of a run I made not long ago which fit the criteria. I could be way off here, but it's sounding mighty close.

Oh and BTW - can I add a transfer to an appropriate facility either via bird if available to fly or I'll take ground either way this baby needs a pedi neuro and it's not looking like we're gonna get it here !

I'm keeping that in the back of my head as well...The child definitely needs to be evaluated by a specialist, so if we don't have one at this hospital, let's get them to the nearest one.

Meanwhile we can do a CT of the head, CBC, Chem Panel, Toxicology (just in case) U/A, and also double check for any signs of trauma while we're at it, expose the child if they aren't already and just take a peek to look for any bruises.

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