Febrile Seizures
How do you manage a child seizing in front of you?
- Look at the time - Turn to left lateral position, place on the floor so that child won't fall - Remove all danger around child - No IV access: rectal diazepam 0.4mg/kg, max 10mg - Have IV access: IV lorazepam 0.1mg/kg bolus, max 4mg - Repeat BZP if refractory, max 2 doses - Phenytoin: 20mg/kg over 20 mins. Give neat. Continuous monitoring of vitals and ECG. - Phenobarbitone: 10mg/kg slow bolus, max rate 100mg/min. Must dilute with normal saline. Send to ICU for ECG, BP, Respi monitoring, EEG. If <1 month, use phenobarbitone first rather than phenytoin.
How do you classify Febrile Seizures?
(A) Simple febrile seizure - <15 mins long - only 1 seizure in 24h - generalised (B) Complex febrile seizure - > 15 mins long - ≥2 seizures in 24h - focal
What is the risk of recurrence for febrile seizures?
30% risk of 2nd febrile seizure 50% risk of 3rd febrile seizure
How would you evaluate a child with suspected febrile seizure? - Investigations
Bedside - Urine dipstick (to check for UTI) Biochemical - FBC (TW Hb Plt) - UECr (any electrolyte imbalances)
What should the parent do if the child spikes a fever?
Fever control ONLY for comfort care. - Paracetamol 10mg/kg Q6H - Brufen 10mg/kg Q6H DOES NOT prevent or reduce febrile seizure occurrence
What is the diagnostic criteria of Febrile Seizures?
Seizures occurring in 1. Children aged 6 months to 6 years old 2. Temperature > 38 degrees AND 3. Absence of CNS infections
What is the risk of epilepsy?
Simple febrile seizure: same as general population Complex febrile seizure: 1-2%
How would you evaluate a child with suspected febrile seizure? - Physical examination
Vitals: febrile HEAD TO TOE EXAMINATION (to exclude CNS infection and localise source of infection) Check hydration status: eyes sunken?, mucous membranes, skin turgor, capillary refill Signs of meningism - Kernig's sign - Brudskinzi sign Neuro examination: - Fundoscopy: check for papilledema - CN examination - UL & LL examination Otoscopy: look for acute otitis media CVS, Lungs, Abdo screen
How would you manage a child with seizure in the ED/ GP setting? *CHECK*
child < 6 months: admit and investigate child > 6 years: refer to Neuro to investigate for epilepsy child suspicious for febrile seizure - Admit to hospital if this is the first time having a seizure - Admit for 24h because risk of recurrence is higher during the first 24h and to ensure not complex febrile seizure
How would you advice the parents on managing febrile seizure at home?
- once the seizure starts, take note of the time on the clock. - place child on the floor, so that he won't fall. - make sure there is nothing dangerous around the child. - turn child on his side so that his tongue won't block his airway. - don't put any spoon or objects into his mouth, may cause him to break his teeth or fracture his jaw. - if at 5 mins, the seizure still does not stop, give rectal diazepam. - for kids <10kg, squeeze out half the tube first. - open up the child's buttock cheeks, squeeze the rest of the medications in, keep squeezing the bottle when you take it out, and immediately press tightly on the buttock cheeks to prevent the medication from coming out - the medication will work in <5 minutes - then call the ambulance to come - give you a febrile seizure patient information leaflet
