EMS A to Z: Febrile Seizure

Show Notes:

From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn

 

You’re dispatched to a 14-month-old male with “seizure”. You arrive to find a no longer seizing, but somewhat post-ictal child laying in his parent’s arms. Further history suggests that he had been sick with a fever, runny nose, and cough for the past 2 days and had an episode of “shaking” that lasted about 60 seconds prior to your arrival and spontaneously resolved. He’s otherwise healthy. You take vitals and find him to be febrile, slightly tachycardic for age. As you continue your assessment, he wakes up more and becomes fussy, fighting you off, and clinging to his parent.  

 

What likely happened? What should you do? 

Sounds like a possible febrile seizure with rapid return to baseline

Any ill-child, particularly who isn’t at neuro baseline should get a BGL checked

 

What about medications? Antipyretics? Benzos? 

Children who are seizing upon arrival, or have a 2ndseizure in your care should receive an age / weight appropriate dose of midazolam, per the AGs 

Antipyretics (like acetaminophen or ibuprofen) can be administered; but evidence that they prevent seizure reoccurrence is sparse

A single study from Japan, in 2018, did demonstrate a decrease in recurrent seizure with acetaminophen use to treat fever

Murata S, Okasora K, Tanabe T, Ogino M, Yamazaki S, Oba C, Syabana K, Nomura S, Shirasu A, Inoue K, Kashiwagi M, Tamai H. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. 2018 Nov;142(5):e20181009. doi: 10.1542/peds.2018-1009. Epub 2018 Oct 8. PMID: 30297499.

 

Can parents keep these kids at home? 

It’s not unreasonable for a child with a likely viral illness, single, resolved, simple febrile seizure to stay at home with supportive care and close follow up

Concerned parent? Poor access to EMS / medical care? Anything not “simple” about the case? Transport.