Seizure disorders: The Daily PANCE Blueprint

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Seizure disorders: The Daily PANCE Blueprint

An 8-year-old male is brought to the ER by his parents due to worsening high-grade fevers. His temperature upon arrival is 105F. He is given Tylenol rectally. He is brought to an ER room but sadly becomes unresponsive and starts jerking his legs and arms continuously. A fingerstick glucose is 140 mg/dL. He continues to be unresponsive and continues having jerky movements even after 8 minutes. What is the next best step for this patient?

A. Administer benzodiazepines
B. Get a STAT CT head
C. Obtain two sets of blood cultures
D. Consult neurology
E. Recheck a temperature

Answer and topic summary

The answer is A. Administer benzodiazepines

A tonic-clonic seizure (aka grand mal seizure) is a seizure that involves a generalized muscle contraction (tonic) phase followed by a clonic phase (rhythmic muscle twitching). Clinical features include rotated eyes, apnea, cyanosis, tongue biting, bladder incontinence, dilated pupils, increased blood pressure, etc. After the seizure, the patient will be in a post-ictal state (confused, fatigued, amnesia, unresponsive). Workup may include fasting glucose, CT head, EEG, brain MRI, toxicology screen, blood cultures, pregnancy test, serum FTA-ABS, electrolyte work-up, etc. The first line for an ongoing acute seizure (lasting 5-20 minutes) is IV benzodiazepines. Long-term treatment of seizure disorder is anti-epileptic drugs (AEDs).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Neurology ⇒ Seizure disorders

Also covered as part of the Family Medicine EOR, Emergency Medicine EOR, Internal Medicine EOR, and Pediatric EOR topic lists

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