A 6 year old is brought in to your ED after a concerning episode at home, suggestive of a seizure, witnessed by his mother.

On arrival, he has an altered mental state, no temperature currently with tachycardia and hypertension.

Issues:
Allocate team and prepare for arrival

On arrival – concurrent assessment and management

Address any immediate life threats, ABC approach

DEFG

Broad differential diagnosis

Consider empiric treatment

Appropriate disposition

Differential diagnosis:

CNS – meningitis, encephalitis, abscess, mass, AVM rupture, HI

Infection – sepsis, pneumonia, UTI, abdominal source, CNS

trauma, choking

Metabolic/ Endocrine – glucose, DKA, dehydration, hypoxia

Drugs and toxin ingestion

Cardiac – arrhythmia, congenital

Seizure – febrile, epilepsy, secondary to any above

Immediate treatment:

attention to ABC – oxygen, fluid bolus, glucose, manage airway

Antibiotics, antivirals

Further Investigations:

ECG, UA

VBG

bloods – this patient has significant neutrophillia which cannot be explained by seizure alone, also SIADH like picture.

CT head

LP

Disposition:

depends on management – ICU/HDU vs Paeds admission