Case of the Month
April 2004

3-year-old female — seizures

You and your EMT partner are dispatched to a reported 3 year-old female in seizure. While en route the dispatcher informs you the patient has a history of epilepsy and that her mother has indicated she has been seizing for the past 25 minutes. Additionally, the dispatcher reports Mom has left the phone so she can administer “seizure medicine.” Due to the length of the ongoing seizure, medics have been dispatched.

You arrive several minutes later and find the patient supine on the floor with Mom in attendance. The mother quickly informs you the child has several seizures a week but today’s was especially long and required 5mg of rectal Diastat to stop the fit. (Diastat is rectal valium prescribed by the patient’s physician for instances of prolonged seizure.)

As you approach the patient, you begin your assessment utilizing the “Pediatric Triangle” (appearance, work of breathing, circulation/skin signs). You note the patient is no longer in seizure and appears post-ictal. Her color is dusky and pale, her work of breathing is erratic with some brief pauses between very shallow breaths and her capillary refill time is less than 2 seconds. You immediately recognize the need for high flow oxygen and instruct you partner to place the patient on 10 liters by mask.

Subsequent evaluation of her vitals reviles a BP 94/p, HR 120, RR 24. Within a few minutes you note the patient’s appearance and work of breathing have improved. Her skin color is now pink and she responds appropriately to her mom’s voice. Medics arrive a few minutes later and continue monitoring the patient during transport to the hospital for further evaluation.

Seizures
It is important to remember that prolonged seizure activity often leads to profound hypoxia requiring aggressive oxygen therapy. Additionally, in this case the patient received a sizeable dose of rectal Valium intended to stop the ongoing seizure. The major side effect of Valium is respiratory depression and in some cases respiratory arrest. Always be prepared to manage the airway of this type of patient with a BVM and provide high flow oxygen via a NRB mask. Continuous and diligent monitoring of a patient’s respiratory status is critical and should be maintained as long as he or she is under your care.

View info on Valium — Epilepsy Foundation (external link)
View info on pediatric epilepsy and seizures — Childbrain.com