Paedlong Case Practice Febrile Seizure PDF

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LONGCASE Scenario–FebrileSeizure   TimeLimit:20mins   Youwillbenotifiedatthe15minutemark.   Instructions:  Youareworkingatastationwhenyouaredispatchedtoa32D1Seizure–Not alert.  Ptisa6mthfemale.   Task:  Toassess,diagnoseandtreatthepatientaccordingtocurrentQASClinical Guidelines   AdditionalInformation  3minstoscene  10minstohospital  Timeofdayis1400hrs  Nobackuphasbeendispatched.Ifbackupisrequired,itmustbeaskedfor duringtheassessment  Thesceneisaneatandtidy,lowsetbrickhouse        Page1of5 

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 ParentonScene:  Meetcrewatdooranddirecttoptinbedroom  History: o Pthasbeengenerallyunwellforthepastcoupleofdayswitharunnynose andtemperatures o ParenttookbabytolocalGPthisamwhorecommendedPanadol4hourly. o ParentstatesthattheyhavenotyetadministeredanyPanadolasthey werewaitingforthepttoawakefromsleep o Whilstparentwaschangingpts.Nappypthadatonicclonicseizurelasting approximately30sec. o Ptnormalvaginaldelivery,39/40gestationwithnilcomplications  PmHx:Nil,noHxofepilepsy Allergies:Nil Meds:Panadol LastMeal:Pt.breastfedbymotherat11am                    Page2of5 

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AssessorInformation   Instructions:  Patientisideallysimulatedbyamanikin   Ptishottotouch  Removalofclothingandcoolingofpatientnecessary,butcaremustbetakennot todecreasetemperaturetoorapidly.  PanadolmaybeconsideredifGCSimproves.  Ifnoattemptismadetocoolpatientinthefirst10mins,patientwilldeteriorate  Candidatemustidentifythatthisisaseriouscondition  Transportandbackupmustbeconsideredearlyinthescenario   QASCPMCPG  Consider   Reversiblecauses   Positioning&O2    Historyshouldinclude:   Anyprovokingcauses   PmHx   Durationofseizure   Iftheseizurehadafocalonsetand thatfocustype     Transporttohospitalandprenotifyas appropriate  

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AssessorSurveys&Observations  ONARRIVAL:Metbyparent,pt.locatedinbedroom  GENERALAPPEARANCE:Ptisbeingnursedbyparent,ptlethargic  Danger‐Nil Response‐Alert A‐Clear B‐Normal C‐Normal  VITALSIGNS Initialassessment 2ndassessment – Post Panadol/cooling GCS 13(E‐3V‐4M‐6) 15 CNS Pupils PEARLsize4 PEARLsize4 Motor/Sensory Nil Nil Rate 30 30 Rhythm Regular Regular RSA Effort Normal Increased Auscultation L=RClear L=RClear Speech Irritable/cries Babbles/followsobjects Pulserate 120R 120R Bloodpressure 100/60 100/60 ECG SinusTachycardia SinusTachycardia CVS BSL 5.7 ‐ SPO2 99%RA 96%RA Temperature 39.1 39.2 Skin Pale,Hottotouch Wellperfused,Hotto touch Other Pain Nil Nil   OPQRST‐Nil HEAD NECK CHEST ABDOMEN PELVIS BACK ARMS LEGS H2T Nil Nil Nil Nil Nil Nil Nil Nil   Observationstoremainsimilarfordurationofscenario  Page4of5 

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AssessorSurveys&Observations 

IFPATIENTNOTMANAGEDAPPROPIATLEY –FEBRILECONVULSION3MINSDURATION‐    Danger‐Nil Response‐unresponsive A‐Clear B‐increased C‐Increased  VITALSIGNS Afterconvulsion 2ndassessment GCS 7 ( E‐1V‐2M‐4) 7(E‐1V‐2M‐4) CNS Pupils PEARLsize4 PEARLsize4 Motor/Sensory Nil Nil Rate 30 30 Rhythm Regular Regular Effort Increased Increased RSA Auscultation L=RAudible L=Raudible stridor/drooling stridor/drooling Speech Moansandgrunts Moansandgrunts Pulserate 140R 120R Bloodpressure 100/60 100/50 ECG SinusTachycardia SinusTachycardia CVS BSL 4.8 ‐ SPO2 95%RA 96%RA Temperature 40 40 Skin Hottotouch Hottotouch Other Pain Unabletorate Unabletorate  

OPQRST‐Unabletorate HEAD NECK CHEST ABDOMEN PELVIS BACK ARMS LEGS H2T Nil Nil Nil Nil Nil Nil Nil Nil  ManageairwaywithpositioningandOP,coolpatient.Observationstoremain similarforduration  Page5of5 ...