Clinical scenario: A 2-month-old having a seizure

You are asked to respond to a daycare center at a local preschool

“Engine 76, Medic 76 Code 3 to Glen Haven preschool, in the daycare area for a seizure. The patient is 2 months old and staff on scene report he is turning blue.”

As you pull up to the preschool and climb off the engine, the school administrator meets you and asks you to hurry. She reports that the staff in the daycare had just put the infant down for a nap when they noticed that he was shaking uncontrollably. The director tells you that the patient was born 6-weeks premature, but has been healthy in the time he has attended the daycare and has been meeting his developmental milestones. He has no history of previous seizures.

When you walk into the room, a staff member hands the child to your partner and says that the boy's name is Henry. The patient appears lethargic and does not appear to have any purposeful movement as you approach. He is cool to the touch and, though he is African American, his nail beds and lips are dusky. When you remove his onesie to auscultate his lungs you see no obvious signs of trauma. The patient does not react to your touches during the assessment.

The daycare provider says that during the seizure the patient appeared to be shaking his right arm uncontrollably and it appeared that he was not breathing. She says that he has been eating well recently and has had fewer than the normal number of soiled diapers.

Your assessment reveals normal lung sounds, pale skin (that improves with blow-by oxygen) and a strong, regular heart rate at 124 beats per minute. A heel-stick blood glucose is obtained with a result of 86 mg/dL. The patient's rectal temperature is 99.0 Fahrenheit.

  • If staff is able to get the patient’s parents on the phone, what questions would you like to ask them?
  • What is your suspected differential diagnosis?
  • What are your first steps for treatment?

Post your answers below in the comments.

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