Febrile Seizures

[A.Anaka]

I am currently working on a presentation about febrile seizures. I have already found many great sources and recorded much information. The downside is that I am having difficulty locating many good sources that pertain to a prehospital care perspective. Which leads me to my questions:
1) How would you treat a pt who you suspect of having febrile seizures?
2) How would this treatment vary from that of an epileptic adult?
3) Besides anti-pyretics, are there any other medications that you would consider?
4) Lastly, Are these seizures always tonic-clonic in nature? Or can they present themselves as an absence seizure?

Although I am posting this in the BLS Discussion area I do hope to get replies from an ALS perspective also. I thank you in advance for your help and insight into this topic.

 

[fyrdog]

Most febrile seizures are treated BLS. If the patient is still hot to the touch or has a high temp on the thermometer then some cooling can be done with a moist towel. Never with Rubbing Alcohol as it can cool a patient too quickly. Febrile seizures are caused by the body temperature rising or falling rapidly. We have tylenol in our guidelines if the patient has not received any prior to EMS arrival. I would consider IV fluids if this was along term illness and the patient appeared dehydrated or shocky.

My experience is that most of the febrile seizures I have been to are over before I have arrived. Normally we have a 3-5 minute response time. The parents are usually the ones that need the most support the first time they see a febrile seizure. 97% the patient gets some O2 and transported.

 

[Meursault]

Another reason rubbing alcohol isn't a good idea (if for some reason you have it with you) is that it's absorbed quickly, and since febrile seizures are a peds problem, it doesn't take a whole lot to be a toxic dose.

Our protocols pretty much specify BLS treatment with an additional glucose stick and IV access for ALS. If the patient goes into status epilepticus, it's treated like a normal seizure.

It may not be prehospital, but the Merck Manuals are always good:
http://www.merck.com/mmpe/sec19/ch283/ch283c.html

 

[Ridryder911]

A seizure is a seizure. Usually, one will not know the initial etiology (if they are actively seizing at the time) until the seizure stops or history of occurrence prior to activity. Thus, the treatment (if actively seizing) would remain the same.

I have yet arrived to an active febrile seizure, or have even seen one in the ER. Usually, they are short lived and stop prior to most help. Again, a history of illness or fever superseding the seizure is a good indicator. I have never read or seen status seizures in regards of febrile seizures. Again, a way of the body defenses to attempt to regulate itself.

I agree with other in regards, I do not believe in deployment of decreasing body temperature rapidly. Usually, removing of excess blankets, infusion of saline (cools the body temp) and room air is sufficient enough. I agree, one has to be sure that other factors such as hypoglycemia is not involved or even the seizure might have caused such, and again treat appropriately.

So in regards to your question:

1) How would you treat a pt who you suspect of having febrile seizures?
See above, if currently seizing same treatment. If suspected febrile, decrease body temp slowly and naturally.
2) How would this treatment vary from that of an epileptic adult?
Usually if the history is the indicator, witnessed seizures is unusual to be seen by the health care providers. Personally, I do not administer additional medications, if febrile seizure is suspected.
3) Besides anti-pyretics, are there any other medications that you would consider? Again, if actively seizing, treatment of seizures. Re hydration therapy. We do not have diagnostic capability to locate the source of why the body is febrile (lab blood work such WBC, blood cultures, to determine if it is viral versus bacterial).

4) Lastly, Are these seizures always tonic-clonic in nature? Or can they present themselves as an absence seizure?

 

[BossyCow]

My oldest had a febrile seizure at 8months. (He's now 22). That event is what started my husband on his career path (FF/Paramedic). That feeling of helplessness, followed by the relief of the appearance of those who knew what to do, convinced him he wanted to be one of the ones who knew what to do instead of the helpless one.

One of the hardest things with a febrile seizure is to get the infant away from Mom's body heat. Speaking from first hand experience, initial instinct is to hold that kid like grim death.