Pediatric lecture

1. FEBRILE CONVULSIONS
Seizure occurring in a child ,
 3 months - 6yrs ( commonly6 months -6 years)
 associatedwithfever
 usuallyoccurswithin24 hours of onsetof fever
 not causedbyCNS infection
 withouta previoushistoryof afebrileseizures.
 Are usuallybrief,generalisedtonic-clonicseizuresoccurringwitharapidrise infever
 If a bacterial infection,especiallymeningitis,ispresent,itneedstobe identifiedandtreated
 Advise familyaboutmanagementof seizures,considerrescue therapy
 If simple – doesnotaffectintellectual performanceorriskof developingepilepsy
 If complex,4–12% risk of subsequentepilepsy.
Simple(typical ) Complex(atypical )
Generalized Focal
Short <10 min Prolonged>10 mins
Single seizure 2 or more seizuresinsame febrile illness
No transient neurological phenomena Present
Recurrence rate-30% - higher if;
 Atypical febrile convulsion
 Positive familyhistory of FCor Epilepsy
 1st fitat youngage < 12 months
 Familyhistorypositive 30%
Risk of epilepsy–2-4%- higher if;
 Atypical febrile convulsion
 Positive familyhistoryof of FC or Epilepsy
Managementof febrile convulsions
 Keeppatientintoleftlateral position
 Structural approach to ABC –
o Checkair way
o Suck outsecretion

2. o Checkbreathing,PR, CRFT insternum <2 sec
o Connectto pulse oximeter
o Give oxygenviaface mask( initially2Lthenaccordingto -
saturationcan improve 4L )
 Checkbloodglucose ( RBS ) - < 3 mmo/l give ivglucose andrecheckbloodglucose
 Waitingfor5 minfrom the beginningnotrelievegive rectal Diazepam0.5mg/kg(available as
5mg preparation) / Midazolambuccal 0.5mg/kg
 (If rectal preparationunavailable use NGtube andgive IV preparationthroughthe tube and
flushitwithsaline )
 Reassess
Still fitting-GiveDiazepam2nd
dose ( dnt give more than2 dose)
Observe forfeaturesof respiratorydepress
Still fittingafter5min
o Give IV Phenytoin18mg /kg or Phenobatbitone 15mg /kg loadingdose
o If no iv line tryintraosseous
If not work sendICU forparalysis