mobey Posted May 22, 2010 Posted May 22, 2010 Just a thought. Perhaps the bulging eyes is from "heaving" while crying. I dunno that I would include them on my DD. Peds seizure always makes me think 2 things: Febrile / Meningitis.
Richard B the EMT Posted May 22, 2010 Posted May 22, 2010 .... where is Arizona Robbins when you need her? Hanging out with Carmen Sandiego? Actually, who is Arizona Robbins?
zzyzx Posted July 10, 2010 Posted July 10, 2010 (edited) As you describe it, this kid is obviously pretty septic. Not a good thing, esp. considering it's only 2 months old. When I did my L&D clinicals a while back, I asked my instructor (long-time L&D nurse) what would cause an infant to have periods of apnea. She said with premies it was typically apnea of prematurity (excuse the Wiki reference, but it's a pretty good basic intro: http://en.wikipedia.org/wiki/Apnea_of_prematurity). She said that for babies born at term, the cause is likely sepsis. In this case the baby is obviously septic. As you may know, the doc was doing a spinal tap to r/o meningitis. Hopefully the seizure was due to the spiking fever and not meningitis or encephalopathy. Afterwards, did your supervisor ask you to take antibiotics? A few years back, I saw what was most likely apena of prematurity in a premie I transported to the ER. Scared the crap out of me (and mom). Baby stoppped breathing, went blue, bradycardic, but then pinked up right away with stimulation. Thanks for sharing this interesting case! Edited July 10, 2010 by zzyzx
BushyFromOz Posted July 11, 2010 Posted July 11, 2010 Has anyone given this kid an antiemetic or maybe even some antipsychotic / anti-seizure meds? Sounds a lot like a dystonic reaction.
DwayneEMTP Posted July 11, 2010 Posted July 11, 2010 The logic actually seems pretty straight forward to me... Eyes were normal, the kid was fine. Eyes begin to bulge and the kid gets sick. So if I just push his eyes back in where they belong, then he should be fine! See? Easy! Anyone have an 'eye pushing' protocol? Ok, so, on the outside chance that that logic tree should be faulty in some way... I'm going with Wendy...though I couldn't have come up with that diagnosis on my best day. It makes the most sense based on my belief that enough ICP to cause the eyes to bulge to such an extent should cause some bulging around he fontanelles, as the scenario states that though they are nearly closed, they are not completely closed at this time. So I'm moving ICP down on my list of differentials. Get a good temp, get him naked if he's warm, and then as others have said, supportive care, but also tape the eyes closed to protect the retinas from drying. Where I work I would launch Flight for Life enroute to the hospital as this sounds like a really sick child and they'll have a 30-40 minute response to me, the doc can cancel should he decide to do so. What an awesome case and discussion!! It's been a while since we've had such an interesting case with so much participation! Cool as hell.... Also, Bushy has an interesting idea. I wonder if the hospital gave him some Phenergan or some such? No n/v in the report, but you never know... Dwayne
BushyFromOz Posted July 11, 2010 Posted July 11, 2010 (edited) i cant see the info on the fontanelles being closed, i must be going blind! Just a thought, perhaps the fontanelles being partially closed is enough to increase ICP anyway, or they have completely closed and that's spiking it? Edited July 11, 2010 by BushyFromOz
zzyzx Posted July 11, 2010 Posted July 11, 2010 "Anyone have an 'eye pushing' protocol?" Dwayne, I'm in California--the bastards took that away from us too!
zzyzx Posted July 11, 2010 Posted July 11, 2010 FYI guys, if you remember simple anatomy, you'll know why increased ICP can't cause eyes to bulge out.
BushyFromOz Posted July 12, 2010 Posted July 12, 2010 FYI guys, if you remember simple anatomy, you'll know why increased ICP can't cause eyes to bulge out. My understanding is increased ICP can cause the vasculature of the ?? retina/ occular nerve head to swell, increasing intra-occular pressure - hence bulging eyes
zzyzx Posted July 12, 2010 Posted July 12, 2010 (edited) I see how you're thinking, but no, I don't believe that could be the cause. With an opthalmoscope you would see papilledema, but that's all. Edited July 12, 2010 by zzyzx
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