Had a dilemma yesterday. What would you do?
Large 12/12 old male.
Immediately work. Sudden onset of fitting. Pyrexial.
Given 5mg rectal diazemuls by paramedics( ~ 5 mins before arrival.) Still
fitting in A&E.(35 min total). Airway difficult, but well pink with sats
100%, on high flow O2. Reasonable ventilation.
Otherwise cap refil normal, HR 190. BM normal.
Anaesthetist called.
Airway still maintained but still fitting.
Gave very slow i.v.diazemuls to 2mg via running saline. Fit terminated.
Child seen by anaesthetist and gradually needs BVM IPPV then ET. Wakes up
after 60 min.
Dilemma - how long do you wait for rectal Diazepam to work?
Do you wait 5+ min whilst child is still fitting?
Any answers on a post card.
Adrian Kerner
SpR A&E
Leeds
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