Pediatric emergency medicine trisk 1434 1434
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Other questions that should be asked include if there was any other significant
medical history (including abnormal developmental history), any significant
surgical history (including the placement of a ventricular shunt), family history of
seizures, other medication use, and travel history to an endemic region
(neurocysticercosis is one of the leading worldwide causes of seizures).
Planning for an Active Seizure
The pediatric emergency physician should address the possibility of further
seizure during the ED stay, especially in patients with a known seizure disorder
admitted to the ED for a breakthrough seizure. The history should focus on home
medications that need to be administered and/or a possible medication load
during the current visit. An active seizure plan should be addressed. Medication
allergies or past adverse events, status epilepticus episodes in the past, or past
medication failures, can guide the clinician toward a better tailored plan in some
epilepsy patients. Some patients may already have an active seizure/status
epilepticus plan laid out by their primary neurologist.
Physical Examination
With the history, a directed physical examination is performed to look for a
possible cause of the seizure. The examination should not be deferred until a
postictal phase has resolved. While limited in neurologic scope, a timely physical
exam may identify a short-lived Todd paresis and other time-sensitive findings
such as those related to trauma and/or ingestion.
Vital signs, including temperature, should be obtained. An elevated
temperature points to a potential infectious cause. The entire body needs to be
examined for the evidence of trauma, either as a preceding cause or as a result of
falling during the seizure episode. The skin should be examined for rashes or
congenital skin lesions.
Dysmorphic features may be associated with other congenital CNS anomalies.
Stigmata of underlying hepatic, renal, or endocrinologic disorders should also be
noted.
The head should be carefully examined for swelling, deformity, or other signs
of trauma. The presence of a ventricular shunt should be noted. The pupils are
studied for shape, size, reactivity, and equality. The fundi are examined for the
presence of retinal hemorrhages or papilledema. The tympanic membranes are
examined for the presence of hemotympanum or for a source of potential
infection. The mouth should be examined for the evidence of tongue biting.
The neck is assessed for meningeal irritation. If there is a history or other
physical signs of trauma, neck immobilization should be maintained until the C-
