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Advanced Study | Pediatrics Part Six

Seizures/Epilepsy: 8% of pediatric transports, many are febrile (fever) seizures. Make note of duration, aura, level of responsiveness, parts of body involved, postictal period, incontinence

  • Simple Partial: no loss of consciousness, motor signs or sensory symptoms
  • Complex Partial: psychomotor or temporal lobe seizures; purposeless activity
  • Absence: formerly called Petit Mal, loss of consciousness, short periods of staring
  • Clonic: jerking muscle activity
  • Tonic: stiffening of the body
  • Tonic-Clonic: formerly called Grand Mal, total loss of consciousness with convulsions
  • Myoclonic: Start/stop abruptly, single or multiple myoclonic jerks
  • Atonic: drop attack, unexpected lack of muscle tone
  • Akinetic: lack of movement
  • Unclassified

Treatment:

  • Nasal airway, suction, ventilation is apnea or prolonged hypoventilation
  • If due to a fever, reduce fever with moist cloths, tepid water, fanning
  • Prolonged seizures, IV Valium or Ativan may be required, rectal diazepam is available for age 2 and older
  • Status epilepticus: continuaous seizure of more than 30 min. or a series of seizures with no conscious period in between.

Meningitis: inflammation of the membranes around the brain and spinal cord. Viral or bacterial. Bacterial is much more serious and contagious. Symptoms:

  • Fever, dehydration, disorientation
  • Bulging fontanelle
  • Loss of appetite, poor feeding, vomiting
  • Seizures
  • Respiratory distress, cyanosis, rash
  • Older children: Kernig’s sign, headache, nuchal tenderness
  • Later symptoms of bacteria in the bloodstream: chills joint pain, sore throat, headache, red spots, exhaustion

Treatment:

  • BSI, could be contagious, use a mask
  • Maintain the respiratory and circulatory efforts
  • Monitor vital signs and cardiac status
  • High flow O2
  • IV bolus of 20 mL/kg as necessary
  • Make comfortable, transport, watch for seizures

Poisoning: extremely high risk because they are so inquisitive. Children 18 months to 3 years account for 30% of all accidental poisonings. Household products, medications, toxic plants, contaminated foods. School age and adolescents poison themselves with alcohol, organic solvents, and drugs.

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