Morning Report

Morning Report: Febrile Seizure

Resident Presenter:  Jen Stuart

Summary: 16 month old male brought in by father after a witnessed generalized seizure.  Father reports that patient had 2 days of fever (Tmax 102F) and congestion, but is otherwise in good health.  VS showed patient to be tachpneic (RR 48, 98% on RA), tachycardic (HR 171) and febrile to 105.5F.  Postictal on exam, floppy with leftward deviation of bilateral eyes. Due to focal neuro deficit, cbc, chem, UA and RPP were sent.  Patient improved with Tylenol PR; EOM were reassessed and intact.  Patient discharged home.

Learning Points:

  • Febrile seizures: < 15 mins, Temp > 38C, 6 months- 5 yrs, do not recur within 24 hrs.
  • Complex Febrile seizures: > 15 mins, recur in 24 hrs, focal, < 6 months or > 5 yrs, without serious infection (meningitis, encephalitis)
  • No LP if well appearing and fully immunized with simple febrile seizure.  Consider in 6mon-12 mon olds with unknown immunization status or if on antibiotics.
  • No VEEG on first simple febrile seizure.
  • Routine cbc, chem, calcium, phos, mag and glucose not recommended.
  • If getting LP, get Blood Cultures too.
  • CTH and MRI not usually helpful

EBM Article / Resources:

  1. Subcommittee on Febrile Seizures, American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. 2011;127(2):389-394.
  2. Tintinalli’s
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