Hello! Seizures. Definition: Disclosures: None. Connecting school and the emergency department 8/20/2018

Transcription

1 Ashley Creedy ARNP Managing Emergencies for School Nurses Pediatric Emergency Department Frank Hello! Jake Connecting school and the emergency department Disclosures: None Objectives: Discuss immediate management of seizures, falls, wounds, hypo and hyperglycemia. Seizures Definition: Seizures are symptomatic of central nervous system or systemic dysfunction and may be representative of an acute or chronic condition (ENA,152). Seizures are the most common pediatric neurological problem seen in the emergency department. There are many different types 1

2 Types of Seizures Most Common Causes Febrile (ages 6 months to 6 years) Idiopathic (approximately 25%) Head trauma Electrolyte abnormalities Infection Generalized Seizure Absence Myoclonic Tonic Clonic Atonic (ENA,153) Seizures and Symptoms Brief lapses in awareness and staring Sudden brief muscle jerks occur unilaterally or bilaterally Muscles become stiff or tense Rhythmic, rapid jerking or flexion of extremities Abrupt loss of muscle tone usually resulting in collapse Partial Seizures (Focal and Local) Simple Complex (ENA,153) Associated with motor, sensory or autonomic symptoms. Consciousness not impaired Associated with impaired consciousness General First Line Management for Seizures Goal: Provide general care and comfort. Keep the child safe. Usually basic seizure first aid is all that is needed. 1.) Stay Calm 2.) Positioning and Comfort 3.) Move Nearby Objects Out of the Way 4.) Make Sure the Child s Breathing is Okay 5.) Don t put anything in a child s mouth 6.)Do Not Forcibly Hold the Child Down 8.) Always stay with the child for the full length of the seizure. 7.) Do not give water, pills or food by mouth unless child is fully alert 9.) Pay attention to the length of seizure from beginning to end of active seizing 2

3 10.) know when to give PRN or rescue treatments and when to call EMS Call EMS for help for: Seizure lasting > 5 minutes One seizure after another without regaining consciousness in between Seizures that last longer or come closer together than usual for that child Difficulty Breathing Seizure occurring in water Secondary injuries Emergency: Status Epilepticus Goals of Therapy Prevent complications from prolonged seizure. Identify cause and treat Prevent side effects from treatment, (respiratory failure, hypotension, etc.) (Phillips, 2018) Status Epilepticus Check ABC s Check a glucose Look for causes Status Epilepticus For seizure activity lasting greater than 5 minutes begin pharmacologic treatment. Every patient in status epilepticus should be transported by EMS to The ED 3

4 A child that has a seizure after a head injury should also be sent to the ED with EMS transport Recap: Safety First! Perform Seizure First Aid Considerations: Type Length Surroundings/situation Incontinence? Does this child have a standing emergency management plan? If so, follow plan. Adminster Diastat if seizure last >5 minutes Discussion and report to parents or EMS Social ramifications if returning to class Discussion Please take the time to discuss amongst your tables scenarios in which you had to manage children with seizures at school. What did it present like? What was your role? Is there anything you think you could have done differently? What questions do you have related to seizures? Please share an experience from the table with the room. Falls What Happened and What Can I Do? Quick Assessment: What do you look for first? Mechanism Determine what happened and how. This will provide helpful information in determining what care is required next. This may be a little more challenging to determine if fall was unwitnessed. Ask this child if alert. If other children witnessed the fall ask each child separately what they saw happen. 4

5 Loss of Consciousness? If yes, how long? Unsure? What is the child s current neurologic status? Does the child seem altered in any way? If there is LOC, it is important to reach out for help/contact EMS If there is no LOC or altered status, what s next? Determine Injury Status Is there midline neck pain? Once neck is cleared or immobilized determine if child can move arms and legs? Ask if there is numbness or tingling. Check for any bleeding Wounds and Wound Care Abrasion Types of Wounds Abrasion Puncture Laceration (simple vs complex) Avulsion Laceration Puncture 5

6 Avulsion Sprains Broken Bones Questions or comments on Falls or Wounds? Signs and Symptoms of Hypoglycemia (happen quickly) Hypo and Hyperglycemia Identification and Immediate Treatment Shakiness Nervousness or anxiety Sweating, chills, clamminess Irritability or impatience Confusion or delirium Rapid heart rate Lightheadedness, dizziness Lack of coordination Hunger and nausea Sleepiness Blurred vision/impairment Tingling/numbness in lips or tongue Headaches Weakness/fatigue Anger, stubbornness or sadness Seizure or unconsciousness (Living with Diabetes, 2015) 6

7 Treatment Consume grams of glucose or simple carbohydrates Recheck your blood glucose after 15 minutes If hypoglycemia continues, repeat. Once blood glucose returns to normal, eat a small snack that includes protein Glucagon The hormone that stimulates your liver to release stored glucose into your bloodstream when your blood glucose levels are too low. If glucagon is needed: Inject glucagon into the individual's buttock, arm or thigh, following the manufacturer's instructions. When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting. (Living with Diabetes, 2015) (Living with Diabetes, 2015) Hyperglycemia What are the Symptoms of Hyperglycemia? High blood glucose High levels of sugar in the urine Frequent urination Increased thirst Diabetic Ketoacidosis (DKA) Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: Shortness of breath Breath that smells fruity Nausea and vomiting Very dry mouth Frequent urination Tachycadia Tachypnea Abdominal pain Goals of Treatment for DKA Fluid replacement Metabolic correction Electrolyte correction Diabetes and Mental Health 7

8 Thank You! DISCUSSION AND QUESTIONS Please discuss experiences you have had with diabetes, DKA or mental health issues with your table. References American Diabetes Association (ADA).Living With Diabetes. (2015, 1 July) Retrieved From: aid-andsafety/general-first-aid-steps Burns, C., Dunn, A., Brady, M., Starr, N., & Blosser,C. (2009). Pediatric Primary Care Fourth Edition. St. Louis, MO: Saunders Elsevier Butwicka, A., Frisen, L., Almqvist, C., et al. Risks of Psychiatric Disorders and Suicide Attempts in Children and Adolescents With Type 1 Diabetes: A Population-Based Cohort Study. (2015, February) Retrieved from: prevalence-of-suicide-attempts-in-adolescent-type-1-diabetes-patients/ Campo, T. and Lafferty, K. (2016). Essential Procedures for Emergency, Urgent and Primary Care Settings. New York, NY: Springer Duderstadt, K. (2019). Pediatric physical examination: An illustrated handbook. St. Louis, MO: Elsevier ENA. (2012). Emergency Nursing Pediatric Course. USA. Emergency Nurses Association. General First Aid for All Seizure Types. (2013, July). Retrieved from: diabetes/treatment-and care/blood-glucose-control/hypoglycemia-low-blood.html Phillips, Julie. (2018, July 20). Can t Miss Pediatric Emergencies. PowerPoint Lecture. Selbst, S. (2015). Pediatric Emergency Medicine Secrets Third Edition. Philadelphia, PA: Elsevier Saunders 8