Coming Soon:
Monthly Pediatric EMS/ED Interesting Cases
Do you have one to share? Email
pedready@jax.ufl.edu
with your case report, content suggestions, upcoming pediatric courses and feedback.
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Encourage others to sign up for the PEDReady listserve & weekly newsbrief, the PE
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ARL, by sharing this link:
http://bit.ly/flpearl
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Background:
- Seizures in kids are common with about 5% of all children having a seizure by the time they are 16 years old.
- Febrile seizures are the most common type of seizures in children.
- Febrile seizures are usually brief and have often ended before EMS arrives at the scene or the patient arrives in the ED.
- About a third of children will have a recurrence of a febrile seizure in the first two years after an initial febrile seizure, so warn the parents! Risk factors for recurrence include:
- Young age at onset (<18 months)
- History of febrile seizures in a first-degree relative
- Low degree of fever while in the emergency department
- Brief duration between the onset of fever and the initial seizure
- Prophylactic antipyretics (acetaminophen/ibuprofen) are no longer recommended for prevention of recurrent febrile seizures, but DO make sure the caregiver has a thermometer and an antipyretic readily available.
- There are two different types of febrile seizures: simple and complex. Most children have simple febrile seizures and the focus in on evaluation of the fever source.
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- Most children do not develop epilepsy after a febrile seizure. The risk is approximately 2% after a simple febrile seizure and 5% after a complex febrile seizure (1% in general population).
- Children with a simple febrile seizure are at no greater risk for serious bacterial infection than children who have not seized, and can be worked up as if they presented with fever and no seizure.
- Studies have shown that measurement of serum electrolytes have no role in the workup of simple febrile seizures.
- Complex febrile seizures do require additional evaluation based on history, age, physical exam and immunization status.
- Always ask about immunization status and attempt to confirm via immunization registries (Florida Shots) or your EMR system.
- Meningitis should always be in the differential diagnosis of a child with complex febrile seizures. About 25% of children with meningitis will present with a new onset febrile seizure; however, they almost always display persistent mental status abnormalities along with other signs of meningitis such as nuchal rigidity, focal seizures and petechia. Beware of children who are unvaccinated or pre-treated with antibiotics.
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Key EMS Management Pearls:
Assess the Situation
- Stable or emergent, sick vs. not sick
- Don’t forget the Pediatric Assessment Triangle: general appearance, work of breathing, skin condition
- Calm the parents, caregivers, bystanders &/or siblings
Determine Stage of Seizure
- Seizure in progress: how long, generalized tonic clonic or focal
- Postictal
- Positive history but no active seizing and not postictal
- History of trauma with the seizure
Basic ABCs
- Maintenance of the airway and oxygenation may require repositioning of the airway and oxygen
- Use C-spine precautions if history of trauma before, during or after the seizure
- Consider a nasopharyngeal airway in postictal patients or post administration of benzodiazepines if there are signs of airway obstruction or low oxygen saturations. Get that toddler’s big tongue out of the way!
Medications if Still Seizing Upon Arriving on Scene or in the ED
- Begin thinking about medication dosing and preparation en route
- Start with a benzodiazepine according to your local policy or with your current age/length/weight-based dosing system (see resource section for dosing recommendations)
- Give weight or color zone in your dispatch/ED report so the ED can begin preparing in advance of your arrival
- Pediatric IV access is difficult in general, especially in a seizing child with anxious parents watching! Consider alternative routes.
- The type of benzodiazepine and route is not the major determinant. The most important determinant in stopping seizures is time to administration. A recent study found non-IV benzodiazepines (NIVB) were given faster than IV benzodiazepines and stopped seizure activity >3 minutes sooner. NIVB=rectal, buccal, intranasal, or IM route.
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Complete History and Exam
- Seizure details and duration, previous seizures
- Fever history and source, meningeal signs, rashes
- Prematurity, immunizations, etc.
Antipyretics
- If fever is present and allowed by local protocol
- Do not administer orally if seizing or postictal
- Must have normal airway and breathing
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Share your pediatric seizure protocols or policies with FL PedReady by emailing
pedready@jax.ufl.edu
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2. NEDARC Webinar Tomorrow
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Optimizing EMS Destination Choice for Pediatric Patients
Tomorrow, June 21, 2019 at 3:00 pm EST
Hosted by:
National EMSC Data Analysis Resource Center (NEDARC)
Presenters:
Jennifer Anders, MD; Jennifer Fische, MD
Learning Objectives:
- Understand why and how pediatric care is regionalized and the effects on EMS systems
- Learn how undertriage, overtriage and secondary transport are sub-optimal for patients and EMS operations
- Review non-trauma pediatric conditions likely to require inpatient or specialty pediatric care
- Become familiar with a pilot pediatric destination tool which incorporates the available evidence base
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3. Upcoming Pediatric Emergency Conferences
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Kid Care Trauma Conference
July 9, 2019 |
Jacksonville, FL
Hosted by: UF Health Jacksonville
Approved for 8 nursing hours and 7 EMS hours
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CLINCON 2019
July 17–19, 2019 |
Orlando, FL
Hosted by: EMLRC
Designed for the entire spectrum of emergency care providers. General conference lectures include
The Pregnant Patient Skills Lab, Tips & Tricks for Blue & Barely Breathing Baby
and more!
Access Brochure
Pre-Con Workshop:
Managing Pediatric Cardiac Arrest
July 17, 2019 | 8:00-12:00 pm
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Symposium by the Sea 2019
August 1-4, 2019 | Boca Raton, FL
Hosted by: Florida College of Emergency Physicians (FCEP)
FCEP's annual meeting & educational conference, Symposium by the Sea, is designed for emergency physicians, residents, students, physician assistants, nurses and allied health professionals interested in emergency care.
Pediatric Trauma Workshop
August 2, 2019 | 9:00 am to 12:00 pm
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Pediatric Care After Resuscitation (PCAR) Course
Dec 2-3, 2019 | Jacksonville, FL
The mission of TCAR (Trauma Care After Resuscitation) Education Programs is to expand the knowledge base and clinical reasoning skills of nurses who work with injured patients anywhere along the trauma continuum of care, particularly in the post-resuscitation phase.
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Thanks for being a Pediatric Champion!
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The Florida PEDReady Program
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