Here's an interesting case…
All my medically savvy friends let me know what you would do. Feel free to post responses in the comments section.
Friday was our first clinical experience. We started the the Rift Valley Children's Village and saw many kids with a variety of neurologic disease. By far the most prevalent was epilepsy secondary to an acute event such as birth trauma or history of CNS infection.
In the afternoon, we were called to the bedside of a 16 mon old F (We'll call her J) who has had a history of a single simple febrile seizure a few months prior. This afternoon she was in her usual state of health when she developed left sided face, arm and leg twitching in the setting of a fever to 104. This episode lasted 20 min and resolved with rectal diazepam. Following this, J was post-ictal with moderate left sided hemiparesis but was slowly improving - both from a mental status standpoint as well as her possible Todd's paralysis. In fact, her left hemiparesis had almost resolved by the time I left her side 20 min later. Our plan was to admit her to FAME clinic about 30 min away. Approximately 15 min later, I was called back to assess a rash. When I saw J, she had developed complete L hemiparesis and now had a new L visual field deficit. She grimaces to pain on her left but does not withdraw. She had not made any sounds since the event. She was purposefully moving her right side and tracking objects to her right. Her reflexes are 2+ throughout and toes are down going bilaterally. There was no witnessed seizure activity prior to this change in her neurologic status - parents and RN were in the room the whole time.
We hopped in a van and headed to FAME. Here is what we had available:
Most antibiotics in IV and PO form, most antiparasitics
Depakote IV and oral, Phenytoin IV and oral, Keppra oral, Phenobarbital oral and Trileptal oral
Diazepam IV
We can perform a STAT glucose, hemoglobin and malaria screen. Basic labs (such as a CBC, BMP or LFTs) are also available but take 1-2 hours to come back.
The nearest hospital to obtain any imaging is 3 hours away. Even if the technology is available, there is no guarantee you can get the scan given the logistical challenges you'll face when you get to the hospital.
So what do you do? Which interventions would you recommend at FAME? Would you drive to attempt to get imaging? (I did and it's a crazy story I'll post later) On the drive over, what type of equipment would you carry with you?
I'll let you know how J did in a later blog post. I'm interested to hear your thoughts.
Lala salaam (good night)
All my medically savvy friends let me know what you would do. Feel free to post responses in the comments section.
Friday was our first clinical experience. We started the the Rift Valley Children's Village and saw many kids with a variety of neurologic disease. By far the most prevalent was epilepsy secondary to an acute event such as birth trauma or history of CNS infection.
In the afternoon, we were called to the bedside of a 16 mon old F (We'll call her J) who has had a history of a single simple febrile seizure a few months prior. This afternoon she was in her usual state of health when she developed left sided face, arm and leg twitching in the setting of a fever to 104. This episode lasted 20 min and resolved with rectal diazepam. Following this, J was post-ictal with moderate left sided hemiparesis but was slowly improving - both from a mental status standpoint as well as her possible Todd's paralysis. In fact, her left hemiparesis had almost resolved by the time I left her side 20 min later. Our plan was to admit her to FAME clinic about 30 min away. Approximately 15 min later, I was called back to assess a rash. When I saw J, she had developed complete L hemiparesis and now had a new L visual field deficit. She grimaces to pain on her left but does not withdraw. She had not made any sounds since the event. She was purposefully moving her right side and tracking objects to her right. Her reflexes are 2+ throughout and toes are down going bilaterally. There was no witnessed seizure activity prior to this change in her neurologic status - parents and RN were in the room the whole time.
We hopped in a van and headed to FAME. Here is what we had available:
Most antibiotics in IV and PO form, most antiparasitics
Depakote IV and oral, Phenytoin IV and oral, Keppra oral, Phenobarbital oral and Trileptal oral
Diazepam IV
We can perform a STAT glucose, hemoglobin and malaria screen. Basic labs (such as a CBC, BMP or LFTs) are also available but take 1-2 hours to come back.
The nearest hospital to obtain any imaging is 3 hours away. Even if the technology is available, there is no guarantee you can get the scan given the logistical challenges you'll face when you get to the hospital.
So what do you do? Which interventions would you recommend at FAME? Would you drive to attempt to get imaging? (I did and it's a crazy story I'll post later) On the drive over, what type of equipment would you carry with you?
I'll let you know how J did in a later blog post. I'm interested to hear your thoughts.
Lala salaam (good night)
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