A 2-year-old child presented to the .ED with a generalized tonic clonic seizure that started 40 minutes priorto presentation. Pre hospital the childgot rectal diazepam 10 mg and Ativan 1 mg.
The child has agenetic disorder and is prone to seizures and is on valproic acid. In theemergency Department the child continues to seize despite 1mg AtivanX2, Fosphenitoin 20mg/kg, phenobarbital20mg/kg. At that point lost the gag reflex and therefore was intubated (toprotect the airways) using Rocuronium asa paralytic. The child was placed on a ventilator, Versed drip and fentanylwere administered. From that point on noseizures were observed.
1)At this point how important would it be for you to monitorthe child's EEG, will you be satisfied with observing a non convulsive state once theRocuronium wears off and defer the EEG orwill you still insists on an earlier EEG? If your hospital has no immediate EEG monitoringcapabilities would you transfer the child?
2)Does your institution have a 24/7 EEG monitoringcapability?,( I found that few even large centers have that).
3) What are your standards of care for transferring thischild to another center? Do you insist on a team of nurse/paramedic/RT? Or doesyour place allow for a resident,paramedic/or nurse only team . I find that there are nouniform standards .
Thanks for reading this long story and I hope to hear formthe list.
Giora (Gill) Winnik
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Maimonides Medical Center
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