Handheld 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 day.

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."


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