Is she perfusing? Nice warm extremities, or cold and pale?
Unless she is in cardiac arrest or dead (not sure if the two are that much different lol) then yes, the question is whether or not said perfusion is adequate to provide adequate neurologic, cardiac, renal and hepatic function.
Limbs and other bits and pieces like the stomach and various odenums can go many hours without adequate perfusion before they die. The heart, brain, liver and kidneys cannot and begin to die quickly which makes patients crook and various medicinos nervous.
Her perfusion is adequate for now, obviously there is something causing decreased respiration and cardiac output so we should be supporting them with the goal of avoiding any secondary injury as we are unable to correct whatever underlying problem caused her to get into this mess.
side note for my benefit...what would be the potential management if oxygenation or perfusion fell perilously despite good airway management.
Perfusion is a marker of cardiac output not ventilation and oxygenation. Potentially if she began to become shocked then we could look at inotropic support and flogging the ticker along with an adrenaline drip however a Paediatric emergency or intensive care consultant Brown is not however in this case its more about supporting the pump to move fluid than lack of fluid itself (cardiogenic cause vs hypovolaemic). What has caused this problem does have some vasodialatory effect so then you could look at things like levophed, noradrenaline and dopamine. Brown would want to have a chat to the little people doctor types first on the telephone machine.
What size orange "DOCTOR" helicopter jumpsuit does Arizona Robbins take again?
Good airway management as far as Brown is concerned in this case would be for the first crew on scene to liberally suction/decontaminate the airway, place an LMA and ensure adequate artifical ventilation. At the Intensive Care (ALS) level or if those funny sky cowboys rocked up out the stratus Brown would automatically be intubating, using RSI if required.
Invasive oxygenation techniques are the realm of those white coated people at the place known for its gaggle of Doctors.
Also, was she acting pretty normally before her seizure? Was this totally out of the blue?
No, she has Brown as a dad so how can she have been normal?
There is no known PMHx
Start with CBC and BMP, I don't know what else would be called for. I can't think what this could be besides toxicological, infectious, or mechanical so (raised ICP from something - bleed, hydrocephalus) Head CT would be nice too I think. If you hadn't told us it wasn't infection I'd be wondering about a LP as well.
CBC is normal as is the head CT .... man giving up our coffee machine for a portable CT was totally worth it
*Brown looks at his shaking hand ....
If there was a significant serum Osm gap would that help any?
Here, you start chest compressions on a child if the patient is:
A. not breathing
and B. has a heart rate of <60.
So a heart rate of 40 would indicate a need for chest compressions, but since the patient is breathing, we would not start CPR.
Either you are thinking of a newborn/neonate .... or is that a crank pipe in your medical directors back pocket?
