Emergency room3y o child arrived by ambulance,In a room with the father ……….”my child hadbubbles coming out of the mouth t...
Emergency roomWhat do you do next ?
Quick assessment3 y old girl is resting comfortably onfathers arms as he is holding on to her.He is upset and nervous,Next...
History and PhysicalVery important to take a very detailedhistoryQuestions that would make difference intreatment:How long...
Our PatientThat was a first episode ,Lasted for 7 minPostictal state for 1 hour afterViral cold for the past weekNever reg...
Febrile SeizuresNot associated with any specific illnessRelated to feverUsed to be thought:– Related to the degree of the ...
Quoting Dr KellerNew understanding of febrile seizures :Not related to the degree of temperatureNot related to the degree ...
Febrile Seizures2-4 % of all children6months- 5 years old,Peak incidence 18 monthsGenetic predisposition – 25%To diagnose ...
Febrile SeizuresSimple – last less then 15 min, manifest ingeneralized tonic- clonic activityComplex- focal or last more t...
Febrile SeizuresLaboratory values non specificLeukocytosis could be from seizures orunderlying illnessEEG- non specificCsf...
Febrile SeizuresWhat is your differential diagnosis ?
Febrile SeizuresMeningitisToxin from infectionDrug reaction- anticholinergics,theophyline, salicylates, amphetamine,cocain...
Febrile Seizures  Treatment:  Simple – watchful waiting, observing  Complex – longer then 10 min activity-Antiepileptic dr...
Febrile SeizuresSupport respiration – all drugs causedecrease in respiratory rateAntipyretic – acetaminophen – 10-15mg/kg ...
Febrile SeizuresComplicationsNoneNo epilepsy riskNo brain damageNo neurologic deficitsNo mental retardationNo learning dis...
Febrile SeizuresPrevention- not advised, due to thepossible overuse of the medications andpossible allergic reaction to me...
Febrile SeizuresWhat is important for parents to know :Inherited traitOutgrow by age of 5 if not soonerRecurrence risk -35...
Febrile SeizuresWhen to refer:If child has neurologic deficits after seizure– refer to the pediatric neurologist.If parent...
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Febrile seusers

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Febrile seusers

  1. 1. Emergency room3y o child arrived by ambulance,In a room with the father ……….”my child hadbubbles coming out of the mouth this morning,and was shaking really bad ! I am scareddoctor!”“ Oh my ….. Doctor - I thought my baby girl wasdying, I did not knew what to do !!!! I just heldher while I called the ambulance, thank God theywere there in 10 min……..”“ Will my child have the brain damage now ?”
  2. 2. Emergency roomWhat do you do next ?
  3. 3. Quick assessment3 y old girl is resting comfortably onfathers arms as he is holding on to her.He is upset and nervous,Next step – start history and physicalWhat questions do we want to ask?What questions are more important ?
  4. 4. History and PhysicalVery important to take a very detailedhistoryQuestions that would make difference intreatment:How long did the seizures last?Were there multiple seizures lasting longerthen 15 min ?
  5. 5. Our PatientThat was a first episode ,Lasted for 7 minPostictal state for 1 hour afterViral cold for the past weekNever registered a fever, but “felt warm”
  6. 6. Febrile SeizuresNot associated with any specific illnessRelated to feverUsed to be thought:– Related to the degree of the temperature– Related to the rate of rise or decline of fever
  7. 7. Quoting Dr KellerNew understanding of febrile seizures :Not related to the degree of temperatureNot related to the degree of rise or declineCan happen even if the temperature is 99
  8. 8. Febrile Seizures2-4 % of all children6months- 5 years old,Peak incidence 18 monthsGenetic predisposition – 25%To diagnose child must be free of any pastfebrile seizures or free of identified braindisease
  9. 9. Febrile SeizuresSimple – last less then 15 min, manifest ingeneralized tonic- clonic activityComplex- focal or last more then 15 min,or multiple with in same illness25% are complex, 75%- simple
  10. 10. Febrile SeizuresLaboratory values non specificLeukocytosis could be from seizures orunderlying illnessEEG- non specificCsf – normalSometimes transient hyperglycemia
  11. 11. Febrile SeizuresWhat is your differential diagnosis ?
  12. 12. Febrile SeizuresMeningitisToxin from infectionDrug reaction- anticholinergics,theophyline, salicylates, amphetamine,cocaineMetabolic disturbance- hypoglycemia,hypocalcemia
  13. 13. Febrile Seizures Treatment: Simple – watchful waiting, observing Complex – longer then 10 min activity-Antiepileptic drugs,Lorazepam- 0.05- 0.1 mg/kgDiazepam- o.2-0.4 mg/kgPhenobarbital- 20 mg/kgPhenytoin- 20 mg/kg
  14. 14. Febrile SeizuresSupport respiration – all drugs causedecrease in respiratory rateAntipyretic – acetaminophen – 10-15mg/kg per rectum or po q 4-6 hoursTreat underlying infectionReassure family – most think child will dieor have permanent brain damage .
  15. 15. Febrile SeizuresComplicationsNoneNo epilepsy riskNo brain damageNo neurologic deficitsNo mental retardationNo learning disorders
  16. 16. Febrile SeizuresPrevention- not advised, due to thepossible overuse of the medications andpossible allergic reaction to medicationsAnticipatory guidance and parenteducation is absolutely a must
  17. 17. Febrile SeizuresWhat is important for parents to know :Inherited traitOutgrow by age of 5 if not soonerRecurrence risk -35% over childs lifetime , 25% over next 12 months
  18. 18. Febrile SeizuresWhen to refer:If child has neurologic deficits after seizure– refer to the pediatric neurologist.If parents frightened or insist onprophylactic treatments – refer them tospecialist to help them better understandbenign nature .
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