"5 year old female, shaking, ? Febrile convulsion"
Hot children are very common, as are convulsions and in all honesty there is no easier job than turning up to hot kiddy. Remove a few layers, give some Calpol and take them to hospital. No carrying involved, no real clinical decisions to be made and very little to go wrong. After all, they normally go hospital not because they need to but because the mother needs to for peace of mind! Unfortunately, this job was anything but 'as given' and anything but simple. We pulled into the cul-de-sac to be see a man frantically waving us down. He was panicked but it didn't really change much, parents who havn't seen a convulsion often panic. He ran ahead of us into the house and up the stairs. We were a tad slower as we were carrying all the kit we might need. Even though we suspected a convulsion we took stuff for a seizure just in case. Thank god we did! The second we entered the room it was clear this was no convulsion. She was foaming at the mouth, eyes back into the head, violent full blown tonic clonic seizure.
"How long has she been like this?"
"20 minutes or so, I thought she would stop but she didn't"
"20 minutes?!"
"Maybe 25, i'm not sure"
This was serious, for us, as serious as it gets. A child with no epileptic history in 'status epilepticus' was of major concern. Due to her age our first line of treatment was rectal Diazepam. We administered it and took her straight to the ambulance, still seizing. We did this as there was little room to work, the bedroom wasn't very clean and we wanted more monitoring equipment. We could also leave immediately if we had to. After 4-5 minutes there was no change in her condition. The nearest hospital was 20 minutes away and we wanted to explore other avenues before we left. I called our clinical support desk (CSD) to request if a second dose of Diazepam could be given IV. They authorised a further dose so we began trying to gain IV access. The ferocity of the seizure made it near impossible to find a vein. My crew mate had one attempt but failed. Neither of us had seen an EZ-IO on a child let alone do one. The idea of drilling into a child's bone to fit a needle is not a pleasant one. This is where 'The Fear' comes into play. The fear of doing something new, the fear of getting it wrong, the fear of the consequences of getting it wrong, the fear of being powerless to stop a child die in your arms, the fear of knowing you have to do it regardless of 'The Fear'. We quickly went through with each other of the point of entry then he went for it. And got it! We set up the 3 way tap, attached the IO needle and administered the drugs.
We had a couple of minutes before it would take effect so started attaching her to more monitoring and taking more OBs. Her temperature was extremely high. The highest I have ever seen. 41.6. We stripped her remaining clothes and around her upper thighs was a non blanching rash. It was highly likely the seizure was caused by meningitis. We gave the maximum dose of Benzylpenecillin, put in a blue call to the hospital and left. Amazingly only 14 minutes had elapsed since we arrived on scene but she was still seizing. Nothing was working and there was nothing else we could do. This is the second stage of 'The Fear'. We now had a 18-20 minute ride to hospital with a little girl who we couldn't make better. A little girl who could quite easily die in our care. A little girl who's parents were watching and questioning your every move. To be fair they were great and just went with it. Everything was ready in case the worst did happen but that was of little reassurance to us. She seized but survived all the way to hospital. When we got her into resus she had been seizing for an hour. The doctors and nurses jumped straight on it. Within 2 minutes she had stopped seizing. Still gravely ill but at least the first hurdle was cleared.
When we left the department, mentally and physically drained, she was still fighting for her life. She was on IV anti-biotics and steroids with her parents by her side. I hate to think the thoughts going through their head. Why did they wait? Could they have spotted it sooner? It's every parents worst nightmare but in reality apart from calling sooner it isn't likely they could have spotted the severity of her condition. They had treated her symptoms but like with all paediatrics, they compensate extremely well and mask symptoms, then crash when it's too late. She was a time-bomb waiting to happen. One of the most frustrating parts of the job is not knowing the outcome of our patients. Not knowing if the 'The Fear' was justified. Not knowing if you made a difference or not. When we left, her prognosis was not good. That length of seizure alone would more than likely cause brain damage if she did survive. The hospital were waiting for transport to Great Ormond Street Hospital for specialist treatment. All we could do was hope.
Three weeks later, we were back at the hospital and a nurse came running over.
"Do you remember the little girl you with status EP you brought in?"
"Yes!"
"She has been discharged and is home, no lasting damage, she made a full recovering, well done!"
That's why I do the job I do. Because those shivers up the spine cannot be replaced by anything. Fact.