Peds...

[medicmole]

At a blood glucose of 1.1 I would say there is not much question as to your 1st treatment. Normal blood glucose is 4 - 6, give him sugar. Hypoglycemia often looks like a CVA since the brain is not getting any sugar it tends not to function very well.

[hammerpcp]

>Can we get a more specific description of this "collapse"? Was it a fall direct to the ground, with no hands put out for protection, how did the child drop, was it stiff or was he limp and slumped to the ground? Was there any motion during that time, any tonic/clonic activity, any coordinated or uncoordinated muscle movement? Was there any alteration in respiration? Any report of gurgling noises or any utterance at all from the child? Was there any deviation of eyes or did they remain fixed to the left the entire time.

Great questions! That's exactly what I asked. The answers were that the pt slumped to the ground. The teacher guided him so there was no trauma. There was no tonic or clonic type activity but he did continue to have tremors primarily in the left arm. No gurgling, no vomit, no tongue biting, no verbal utterances. Unknown if any alterations in respiration.

I also want to know- you said the child is standing but still unresponsive? Did he get up right after he fell? Get some info about this transition from on the floor to back standing up. Did he just get up and then was altered again, or was he out of it the whole time? Hase he been responsive at all?

Another great Question! I asked that one too As it turns out the child had remained lying on the floor until the firemonkeys came in and promptly stood him up. The pt has been in his current condition for approximately 20 minutes so far with no changes.

Crazy,

to quote hit the quote button at the top of the boxy thing (very technical I know).

Or you can type in [q u o t e =hammerpcp] text to be quoted [/q u o t e]

Without all the spaces though.

[crazycanuck]

text to be quoted [/q u o t e]

Without all the spaces though.

OK, I think I got it, thanks!

Follow-up vitals and BGL on the way.

I think it would still be advisable to work this child up metabolically as well as possibly neurologically, as this is a pretty severe episode of hypoglycemia in a child this age. Also, if I am correct- hypoglycemia will more often result in tonic-clonic seizures, as opposed to the deficits shown here. Though it's possible this is simple occurrence of hypoglycemia, I'd still like to err on the side of caution and be sure this child is transported appropriately and worked up. ED intervention will R/o anything severely wrong metabolic wise, check ketones, CO2, BGL, basic CBC, continue fluids and dextrose. Often times I think these episodes in children can be overlooked when the immediate cause is not apparent and then take a wait and see approach or wait for a repeat occurrence. Any insight into the underlying cause of it? No illness as you stated, so no n/v, recent viral infx-, but any change in meal patterns, reduced intake?

OK now that we have a BGL, what was the response to treatment and follow-up BGL. Fluids and dextrose. Repeat vitals, any change in LOC, any more info for us.

[akroeze]

I admit to not reading every single post but one of my first thoughts was absence seizure.

[MedicRN]

Hypoglycemia (most probable) vs Absence Seizure

or

Absence Seizure as a result of the hypoglycemia

Either way, he needs dextrose. D50 or D25 as per local protocol. Transport and let ERDoc make sure nothing else is amiss. Oh, and make sure the parents are aware and what they want to do.

[crazycanuck]

If this was neuro and was in fact a seizure, I'd be leaning toward partial seizure, but not necessarily absence. Absence is usually much more transient, unless this initial presentation was a status event. Could be complex partial, but they can look very similar and we need more info about motor behaviour, automatisms etc as well as EEG findings would be a way to distinguish the variant.

However, I would want more neuro information to present to the ED that would give them more indicators if they did think it was a seizure from neurological cause. If theyare leaning to neuro they will have a ped neurologist look into it, and they have the specialty knowledge required with the input form the ER Doc to investigate this further.

With that low BGL, I'd lean toward that being the cause, but let's not throw this out the window just yet. Just to play the opposite side, what if it was a seizure that brought on the low BGL, possible though I'm not sure this is possible so rapidly, with the s/sx being 20min in duration I would guess it would take longer for a seizure to reduce a BGL so rapidly....anybody have any ideas on that end?

[Eydawn]

Let's fix what you can first and get some dextrose going.

Does the kid respond in any fashion to any of your stimuli? Does he show any signs of recognition to verbal stimuli? Any trauma other than the gentle slump to the ground? What's his muscle tension like? Does he take any meds from the school murse? Head to to exam reveals: ?

Got any parent info forthcoming? Siblings that could be of assistance? Prior history of anything like autism, developmental disabilities, ADHD, etc?

Did I miss it... BP?

Wendy

CO EMT-B

MI EMT-B

[hammerpcp]

1mg glucagon administered subcutaneously with no change.

I would call this a complex partial sz.

Pediatric pts don’t tend to have grand mal aka generalized motor type sz.

As previously stated pt has no meds, no hx, no allergies.

Who wants to get moving with this kid?

Good idea.

Enroute pt's tremens begin to get a bit larger- still primarily in left arm.

Pts Sat drops to 92 and he seems to have a decreased respiratory effort and rate.

Side note: My vehicular laboratory is currently not working.

Epilepsy foundation

[Acosell]

1. Introduce self to patient and bystanders.

2. Assess responsiveness of the child.

3. Ensure an adequate airway.

4. Assess WOB/adequacy of breathing.

5. Ensure the patient has a pulse.

6. Question the caretaker of the child for a history as your partner takes a full set of vital signs, search for medic-alert tags.

7. Take a CBG reading.

8. Move the patient to the stretcher, ask if anybody will be accompanying the patient and if their parents have/will be notified – inform the person responsible of the intended destination.

9. Vitals q5. Consider ALS intercept

10. When the patients respiratory effort drops, reassess ABCs, begin ventilating with the BVM. Call for ALS intercept

11. Recheck CBG after 20 minutes, reassess LOC.

12. Transfer care to the hospital – report findings, including evidence leading you to believe the patient had a seizure.

13. Complete paperwork.

14. Drive back to base while deciding if your new partner is an idiot or not.

[spenac]

"1. Introduce self to patient and bystanders"

That might take a while large group shaking hands names etc. Ok I get it you introduce by saying the best EMT ever is here not get the h... out of the way. Right. Cool catch you later.