Friday, October 11, 2013

Fever seizures

Had placement today, it was my last - at least I think so. I've enjoyed it and today was no different.

My preceptor seemed to have enough trust in me to attend to one of the physicals today, and I nailed it.

We saw a little one who had bilateral ear infections - boy did they look painful!!! OUCHIE

Then we had a dad who brought his 5 month-ish daughter in for a check up cause his wife thought her cold had gone into her chest and was sounding congested - NP said nope but dad had also brought his approx. 2 yr old. And boy did HE look sick!!! He certainly looked MUCH worse than the one he came in for in the first place!

Dad indicated that kiddo had been fighting this "thing" for almost 3 weeks - had gone to an urgent care and the docs there had prescribed amoxicillin - which he had just recently finished. His nose was draining but not purulent - it was clear. When the NP touched him though, immediately she asked for a temp and it turned out that he had spiked one - 102.4 F (39.1 celcius) - and his poor eyes just told u everything about how sick he felt. We went out to get him tylenol and I went back in to give it to him - and take it he did. Then went back out. The NP was unsure what she was going to do plan wise because aside from the temp, his sinuses didn't look infected, no nasal drip indicating infection, chest clear - so what to do? And while we were discussing this amongest ourselves, the dad brought the kiddo out to the main area and exclaimed "he's having a seizure".

Sure enough, tonic clonic seizure (really rigid then the convulsions - and loss of consciousness - and his eyes rolled back in his head)- NP instructs the dad to put him down on the ground and she ensured that he didn't aspirate - tells the clerk to call 911 and stayed with him. Unfortunately there was no suction machine so I grabbed a kleenex so that she could wipe out his mouth - the seizure lasted approx. 2 minutes. When he started to have secretions in his mouth she turned him on his side and wiped his mouth again. Thankfully no vomitting, which meant that he kept down the tylenol. He also lost control of his bowels during this time. But that was the least of our concerns!

Once the fire fighters arrived, he had just completed the seizure and was in the "post ictal" phase of the seizure which is where they are no longer seizing but have not regained consciousness. Or if they do regain it, it may only be for a second. Our little guy went from the tonic clonic to post ictal then back to tonic clonic. Before he started to seize again the NP was able to get him to respond and open his eyes and his pupils were equal and reactive (good sign) - then he started to seize again, but it didn't last long before he went back to the post ictal phase. The guys arrived and put oxygen on him (didn't realize that there was oxygen in the office - don't know where anything is pretty much in that office!) and a pulse ox on him. His oxygen saturation was 94% without the oxygen and with blow-by oxygen it went to 100%. I tried to put the oxygen mask on him but he swiped that away so I just held it next to his face. You just felt for the little guy and his daddy who was standing near by just staring and trying to get a hold of his wife who was at work.

I got his little girl's stuff all together and got her in her car seat and brought her to him. Then once the paramedics showed up, they took the little one and away they all went with dad and baby in tow.

Wasn't expecting that for the last day of clinical - tho that's sorta how one of my last days of clinical placements went when I was doing placement on my unit at my hospital - so maybe it's a good omen for me???

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