Seizure =/

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user842

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I am an AEMT in training, but was riding on a BLS unit. I had a 7 year old child who apparently had a seizure in the supermarket. When he was in the ambulance, he just looked a little sleepy, had urinated on himself, and his vitals were relatively normal, but the pulse ox was barely working on him. My partner put him on a NRB. However, during transport, as I was trying to get a BP, his left arm went rigid and his pupils were drifting when I opened his eyelids but were still constricting to light. He has a history of speech delay and had one febrile seizure in the past. By the time we were at the hospital, the child woke up and was pretty much alert and oriented.

I think I messed up. I didn't tell the ER nurses that he could have been decorticate posturing, and idk... it seemed like they were jumping to conclusion that he had another febrile seizure. I'm so paranoid that I messed this kid up, like I feel like he could have went into arrest or stroked or something else that's serious =(
 
He probably had another seizure during transport...
 
I don't think you have anything to worry about. Always remember that it is hard to kill people. There is nothing you could have done on a BLS truck. As for not passing along some information, we are going to do our own assessment in ER. Even in the other scenarios you thought of (stroke, arrest) there is nothing else you could have done.

Why do you feel they were jumping to conclusions? Was the kid febrile? If so and he has a h/o febrile seizures, shoot for the horses, not the zebras.
 
I know, I'm just being so paranoid right now. The nurses in the room asked the mother if he was warm today and she said yes, so they said "it could be another febrile seizure." I don't think he was warm to my touch though. His presentation was just weird, like he went from unresponsive in the rig to awake in the hospital.

This has been giving me so much anxiety! Like decorticate posturing is a bad sign and I didn't open my mouth. =/
 
user842 said:
I know, I'm just being so paranoid right now. The nurses in the room asked the mother if he was warm today and she said yes, so they said "it could be another febrile seizure." I don't think he was warm to my touch though. His presentation was just weird, like he went from unresponsive in the rig to awake in the hospital.

This has been giving me so much anxiety! Like decorticate posturing is a bad sign and I didn't open my mouth. =/
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Going from unresponsive to awake is a pretty normal finding in seizure patients. It's a postictal period
 
user842 said:
I know, I'm just being so paranoid right now. The nurses in the room asked the mother if he was warm today and she said yes, so they said "it could be another febrile seizure." I don't think he was warm to my touch though. His presentation was just weird, like he went from unresponsive in the rig to awake in the hospital.

This has been giving me so much anxiety! Like decorticate posturing is a bad sign and I didn't open my mouth. =/
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While yes, you should probably pass that finding on, you were not equipped to do anything about it and the outcome remained the same. It isn't like the ED bases their treatment only on your report...
 
Why are you so hung up on the idea of decorticate posturing? That would be a sign of brain stem herniation, which he certainly did not have if his LOC improved at the ER.

You'll eventually notice that some patients just play possum (or overdramatize) on scene or in the ambulance and then miraculously recover once they're at the ER. There are a bunch of potential reasons for this phenomenon, but try not to get too worked up and your patients won't either.
 
True posturing typically happens late in the course of the injury/illness and stays that way until further deterioration. If they woke up afterwards without any further treatment, it wasn't posturing. Sounds like another seizure en route to the hospital.
 
Okay, thank you guys for all your responses. I know I am getting worked up and I should remind myself that he was back to normal within ten minutes I noted that >.< Though I'll be sure to clarify anything in the future.

It's all the internet reading that get's me worked up lol
 
Hmmm, basically he was on the stretcher laying supine. His left arm folded across his chest, there was no jerky movement. But when I reached to get his BP his arm was hard to move and kept trying to go back into that position. Almost like the second video when the boy folded his arm in. :(
 
Sounds like a seizure to me. People that are posturing generally don't wake up any time soon, if at all.
 
Decorticate posturing has numerous causes, though we are all told brain injury/herniation and other causes are usually left out. Even as a doctor (not a neurologist), the differential is incompletely taught. Regardless, I've seen many seizures over the years and I've seen decorticate posturing that usually occurs during the tonic phase. Not all seizures manifest as tonic-clonic/grand-mal, mind you. If the kid returned to baseline then what you saw was likely a tonic seizure. Also, 7 is a little old for a febrile seizure. Though small, febrile seizure is a risk factor for development for epilepsy later in life.
 
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