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EMS has brought in an 8 month old child who had a generalized tonic-clonic seizure at home. The child has a history of 2 prior febrile seizures, starting at age 6 months, and is not on any long-term anticonvulsants. There is no other significant PMH. The child was given IM Ativan 1mg by EMS with resolution after 10 total minutes of seizure. Vital signs are temp 37.9, HR 160, RR 10, BP 72/42, O2 sat 90% room air, weight 7 kg, POC glucose 110. An IV is now in place. What is the MOST appropriate first intervention, assuming all can be instituted within the same amount of time?
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December 12, 2019 at 9:57 pm
D) Bag-valve-mask ventilation
The child is demonstrating respiratory failure with a hypopneic respiratory rate of 10 and low O2 saturation. Simply adding oxygen or positive pressure will not be helpful if the child is not spontaneously taking sufficient breaths. Flumazenil is contraindicated as reversal of benzodiazepine effect could precipitate more seizures.