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3-15. Seizures

Seizures are caused by abnormal discharging of a group or groups of neurons in the brain. The abnormal electrical discharge can be caused by head trauma, meningitis, elevated core temperature, or physiological abnormalities.

a. History. Ask these questions of or about the child:

(1) Has the child ever had a seizure before? If so, how often? Have the seizures occurred when the child has had a fever?

(2) How many seizures has the child had?

(3) Does the child have a history of trauma? Diabetes? Headache? Stiff neck?

(4) If possible, obtain a description of the seizure. Was the child's whole body affected or just one area of the body? Did the seizure start in one area of the body and progress to other body areas? Did the eyes deviate to the left or to the right?

b. Physical Examination. Pay particular attention to these areas while you are examining the child:

(1) Level of consciousness. Observe and note what the child can and cannot do. Does the child respond in a logical manner to verbal stimuli? Does the child just drift off to sleep abnormally? If he does this, can he be awakened easily? What kind of stimuli is necessary to awaken a child who has drifted off to sleep? Can talking in a normal voice wake him or must you scream to waken him? If nothing can waken him, does he respond to physical stimuli by moving?

(2) Evidence of fever or dehydration. A child with fever will have hot, flushed, dry skin; generally, poor skin turgor.

(3) Signs of injury. Check for signs of trauma to the head, tongue, or anywhere else on the body.

(4) Neurological state. Perform a thorough neurological examination. This examination will be repeated several times. The changes in the child's condition and the direction of those changes are very important. When you are doing the neurological examination, be particularly attentive to these areas:

(a) Position of the child. In what position was he found? His position can sometimes indicate certain injuries.

(b) State of consciousness. This is part of the neurological examination and is mentioned in paragraph b(1) above.

(c) Speech. If the child is conscious, is his speech clear or garbled? Even if his words are not in the proper order, is he still able to understand what is said to him? Can he follow simple commands; for example, "Squeeze my hand."

(d) Movement and sense of pain. When you are moving the child's extremities, does he know that you are moving his fingers or toes up or down? Does he realize that you are pricking his toe with a pin? Does an unconscious child react to painful stimuli; for example, pin pricks.

(e) Pupils of the eyes. Look at the child's pupils to see if they are equal in size. Are his pupils abnormally constricted or dilated?

(f) Eye movements. Can the child's eyes follow your moving finger?

c. Treatment. The goal of treatment is to maintain the airway and prevent the patient from injuring himself. To do this, proceed as follows:

(1) Sponge the child with lukewarm (tepid) water if he has a fever.

(2) Place the child on the floor away from objects that can cause injury. DO NOT restrain him.

(3) Maintain the child's airway.

(4) Administer oxygen to him and assist with ventilations, if necessary.

(5) Start an IV with D5/W (5 percent dextrose solution in water) by microdrip infusion (well secured), as ordered.

(6) Be prepared to give D/50 (50 percent dextrose injection) in the dosage of 1 ml/kg.

(7) Once in the treatment facility, if the child's seizures do not stop, prepare to give diazepam (Valium®) in a dose of 0.3 mg/kg. Give this medication in a slow IV over a period of 1 to 3 minutes.

3-16. Febrile Convulsions

David L. Heiserman, Editor

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Revised: June 06, 2015