Trainee Advanced Clinical Practitioner Diary- Day 16 - Critical Care Practitioner

Trainee Advanced Clinical Practitioner Diary- Day 16

Febrile convulsions, eczema.

Febrile Seizures

Febrile seizures. BMJ 2007

Febrile seizures occur between 3 months and 6 years. Majority of children have their seizure on the first day of illness. Degree of fever is variable. Measured fever is most often above 39 degrees.

Studies in febrile seizures: I. Height of Body Temperature as a Measure of the Febrile-seizure Threshold. Peadiatrics 1959

Generally accepted criteria for febrile seizures include:

  • A convulsion associated with an elevated temperature greater than 38°C
  • A child older than three months and younger than six years of age
  • Absence of central nervous system infection or inflammation
  • Absence of acute systemic metabolic abnormality that may produce convulsions
  • No history of previous afebrile seizures.

Seizures can be simple (generalised, lasting less than 15 minutes, do not recur in a 24 hour period) or complex (focal, last longer than 15 minutes or occur more than once in 24 hours).

Studies indicate that those patients with complex seizures are at higher risk of repeat episodes.

Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010

Predictors of Epilepsy in Children Who Have Experienced Febrile Seizures. NEJM 1976

 

History

  • seizure characteristics
  • duration
  • presence of focal features
  • immunisation status

The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine. NEJM 2001.

MMR2 immunization at 4 to 5 years and 10 to 12 years of age: a comparison of adverse clinical events after immunization in the Vaccine Safety Datalink project. The Vaccine Safety Datalink Team. Peadiatrics 1997

  • family history/social history
  • known neurology.

Prenatal exposure to cigarettes, alcohol, and coffee and the risk for febrile seizures. Peadiatrics 2005

Examination

  • level of conciousness
  • Meningismus – A group of symptoms similar to meningitis (stiff neck, reaction to light and headache) without inflammation of the membranes lining the brain.
  • tense or bulging fontanelle.
  • Post ictal drowsiness usually resolves within 5 to 10 minutes.
  • Signs of infection- ears, throat etc.

Treatment

Most febrile convulsions have resolved by the time treatment is sought. If seizure activity continues beyond five minutes then intravenous benzodiazepines should be given.

Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children (Review). Cochrane. 2010

Feverish illness in children: Assessment and initial management in children younger than 5 years. NICE 2013

EMBasic Podcast on Febrile Seizures.

Eczema.

Atopic dermatitis is a chronic, pruritic, inflammatory skin disease.

Clinical features include:

  • skin dryness
  • erythema
  • oozing
  • crusting
  • pruritus (itching)

p-05-Parts-on-Body-with-Eczema

Elimination of exacerbating factors.

  • avoid excessive bathing without moisturisation
  • avoid heat and low humidity
  • avoid emotional stress
  • avoid solvents and detergents.

What causes worsening of eczema? A systematic review. Br J Dermatology 2006.

Standard treatment is based around the use of moisturisers and anti inflammatory preparations.

International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies. Br J Dermatology 2003

Atopic eczema in children. Management of atopic eczema in children from birth up to the age of 12 years. NICE. 2007.

Maintenance of skin moisture is important. To maintain skin hydration, emollients should be applied at least two times per day and immediately after hand washing and bathing.

Antihistamines are used to treat both puritus and eye irritation. The evidence is weak supporting their use.

An evidence based review of the efficacy of antihistamines in relieving pruritus in atopic dermatitis. Arch Dermatol. 1999

mild_medium_severe_eczema_copy

Severity:

  • Mild- Areas of dry skin, infrequent itching (with or without small areas of redness); little impact on everyday activities, sleep, and psychosocial wellbeing.
  • Moderate- Areas of dry skin, frequent itching, redness (with or without excoriation and localized skin thickening); Moderate impact on everyday activities and psychosocial wellbeing, frequently disturbed sleep.
  • Severe- Widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation); severe limitation of everyday activities and psychosocial functioning, nightly loss of sleep.
 

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