I was called to a PreK class today. During naptime, a student apparently started "convulsing" per teachers. (I only add the "" because I did not see this - both of the teachers were adamant that it looked as though he was seizing). When I arrived, he was standing up and unconsolably crying. His neck was angled to the side like he was unable to move it, and so that it looked like he was convulsing. I tried to get him to calm down and talk to me, but he just anxiously pointed at his throat. He can't move his neck, cant talk, and is anxiously crying. So I call 911 right away, we carry him to the clinic. Spo2 was okay, < 96%. Slowly he is calmed down and says "I can't talk." The paramedics get here right when mom calls back. It turns out, this happened to him a year ago and the doctors didn't think it was a seizure. Vital signs were normal at this point, and he was responsive and talking - just seemed a bit lethargic. Mom ended up taking him to the doctor herself.
Has anyone seen anything like this before and did I do everything okay? I kind of felt silly that he was okay once the paramedics get here, but I don't regret calling 911. This is my first pediatric job though, I do have insecurities about my assessment skills and I rather just be overly cautious.
I thought about that as well, but thankfully that's not what it was. By the time EMS arrived the "episode" was calming down and there were no signs of respiratory distress.
I did a lot of research last night and I read about Todd's paralysis - paralysis (usually of one side of the body) which can last a few seconds to a few hours after a seizure and sometimes causes the inability to speak. I have a feeling this might have been what happened. If the poor baby suddenly couldn't move his head or speak, he was probably extremely frightened.
AND It did happen again today though, so I'm pretty sure it was a seizure. There was no "paralysis" this time, but the same seizure-like activity. Mom is taking him to a neurologist tomorrow.
AND It did happen again today though, so I'm pretty sure it was a seizure. There was no "paralysis" this time, but the same seizure-like activity. Mom is taking him to a neurologist tomorrow.
Great news that he's getting seen by neuro! By calling EMS and escalating the situation, you kind of started the ball rolling to dig a little deeper for answers. If you had any doubts, I think this follow up shows your decision was definitely the right call. In general, it's always better to have EMS and not need them, than need them and not have them.
As a nurse as well as an EMT, I would have taken the same steps as you did.
From the EMT perspective, I (and most of my EMS colleagues) would much rather respond and not transport then get called after a delay where things progressed. Kids are tricky at times, they can decompensate quickly - especially in neuro and respiratory situations and your scenario had potential for either.
Specializes in ICU/community health/school nursing.
22 hours ago, vampiregirl said:
As a nurse as well as an EMT, I would have taken the same steps as you did.
From the EMT perspective, I (and most of my EMS colleagues) would much rather respond and not transport then get called after a delay where things progressed. Kids are tricky at times, they can decompensate quickly - especially in neuro and respiratory situations and your scenario had potential for either.
I appreciate you popping on and offering this pearl. Because we often second guess ourselves in ambulatory care in general, school nursing in particular. We may be used to having a million policies and procedures and a skilled respiratory team at our fingertips and being alone in a school...we do question ourselves!
update: They started treating him for seizures. He started Keppra and has an EEG and MRI coming up. No episodes since he started he medication, and hopefully no more to come! Thanks for all the advice and confirmation, its so hard not to doubt yourself... especially when you are the only one with medical experience around!
lifelearningrn, BSN, RN
2,622 Posts
It sounds like they need to do some testing on him.