Electronic Database Saves Seizing Infant
By Dr. Ted Koutouzis
"On July 4 2001, I just arrived at my evening shift at a low
volume suburban E.D. The emergency dept was even quieter than usual
with a near empty waiting room. After getting settled in and talking
with a fellow colleague, the charge nurse informed me of a 5-month-old
infant who was just brought in to room one. I was told the child
was having a seizure. The patient's mother was present but hysterical
and could not provide a clear history.
After briefly questioning the mother, I was told that they had
been at the park all day. The infant was drinking a bottle of juice
when he began to gag and shake. It appeared that the infant had
been seizing for over 30 minutes prior to arrival. I then focused
my attention on the infant.
A primary survey was performed. Tonic-clonic seizing was observed.
Airway intact, bilateral coarse breath sounds. Patient was attached
to cardiac monitor and pulse oximetry. Sinus tachycardia was noted,
blood pressure was normal and O2 saturation 99% on room air. Blood
glucose-114mg/dl, Temp 98.4 rectally.
Intravenous access was obtained and labs drawn. By definition,
the child was in Status Epilepticus. I referred to a detailed card
in PEPID (Portable
Emergency & Primary Care Information Database) that deals with
Status Epilepticus in the pediatric population. Ativan IV was given.
After five minutes, the patient continued seizing, and there was
no time to load Dilantin, so IV Phenobarbital was given. Shortly
thereafter, the patient vomited and dropped his oxygen saturation
precipitously. The infant was vomiting clear water and it was later
learned that he had pproximately 16oz of tap water at the park that
It was clear the child needed to be intubated and the pediatric
RSI protocols in PEPID were helpful.
After successful intubation, the lab called to inform us of a sodium
concentration of 105. The infant still showed seizure activity.
I realized I would need to correct his sodium immediately in order
to eliminate the seizure. I had never been faced with this situation
and was unsure of dosage or administration of hypertonic saline.
This information was again quickly obtained from PEPID.
After this case, I realized PEPID's power and it's ability to assist
with critically ill patients. I was able to quickly confirm dosages,
table sizes and treatment protocols almost instantaneously in a
stressful life-and-death situation. There is no other resource as
helpful and potentially life-saving."