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Pediatric cases

He went stiff and shook, and now he will not wake up properly

A 20-month-old with a fever since the morning had a two-minute convulsion at home. His parents thought he was dying.

Age20 monthsWeight11.5 kg

Pediatrics

20 months old· toddler11.5 kgboy, Pediatric emergency, room 4Fictitious educational patient
Caregiver
Mother: 'He had a temperature this morning and was a bit clingy. At lunch he went stiff, his eyes rolled up, and his arms and legs jerked for about two minutes. His lips went blue. Then he was floppy and asleep. He is more awake now but he is not himself.'
Immunizations
Up to date. Measles, mumps and rubella vaccine given 8 days ago.
Development
Walking since 13 months, about 20 words, points and plays.
Previously wellDevelopment normal

Day 0 · 13:20

Forty minutes after the event

He is drowsy on his mother's shoulder but rouses to voice, pushes your hand away, and cries. No further seizure activity. Bedside glucose 5.2.

Vitals

HR150high for ageBP94/58RR30SpO297%T39.4high for age

Read against the toddler band (1 to 3 years): HR 98 to 140 awake, RR 22 to 37, hypotension below 72 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

Examination

  • Neurological: Drowsy but rousable, moves all four limbs symmetrically, pupils equal and reactive, no neck stiffness, fontanelle closed.
  • ENT: Red bulging right tympanic membrane. Throat mildly red.
  • Skin: No rash. Blanching test negative for petechiae.

Which features make this a simple febrile seizure, and which single thing would change that?

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