I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Tuesday, 11 February 2014

Febrile Seizures

Paediatric blue call for a twitching hot tot - you either love them, or hate them. As most of the time the child is pretty much back to normal by the time they arrive in the ED, it's easy to get a bit blaze about Febrile Convulsions or Febrile Seizures.

Febrile seizures: Seizure accompanied by a fever in the absence of inter-cranial infection due to bacterial meningitis or viral encephalitis.

They happen in 3% of children, between 6 months and 3- 5 years of age. The peak incidence is 18 months. Only 6-15% of seizures occur after 4 years. They are normally brief, with a 30-40% risk of a further attack.
10% increased risk if child has first degree relative with febrile seizures
A febrile seizure is more likely the younger the child, the shorter the duration, lower the temp at seizure and family history.  1-2% lifetime risk of epilepsy, same as all kids - complex focal have 4-12% risk

- Short duration (<15minutes)
- Single seizure
- Brief post-ictal period
- Fever identified
- Prolonged seizure (5 - 10min) more likely to have a recurrence.

Minimal evaluation needed
Urinalysis may be indicated - UTI common cause
Lumbar Puncture - only if child is not well looking, fully immunised, presenting with a simple febrile seizure. It
For complex seizure, consider bacterial meningitis as a cause - it can be difficult to clinically rule it out.

As per departmental policy. Example from Manchester on the CEM website here.
If seizing, follow status epilepticus guidelines.
No evidence on duration of observation, although 24 hours has been suggested.

Normal seizure advice
Antipyretics do not prevent convulsions but may provide comfort. Diazepam also should not be used as prophylaxis.

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