EMSC Connects

January 2025; Volume 14, Issue 1

Utah Emergency Medical Services for Children

Pedi Points

Tia Dickson RN, BSN

PCH Trauma RN, Utah EMSC Nurse Clinical Consultant

Seizures are the most common pediatric neurologic emergency and account for around 15% of all pediatric EMS calls. 

Seizures are the most common pediatric neurologic disorder. Four to ten percent of children suffer at least one seizure in the first 16 years of life. The incidence is highest in children less than 3 years of age, with a decreasing frequency in older children.

The Doc Spot

Pediatric Seizure and Status in the ED

Maija Holsti, MD

Primary Children’s Hospital

Excerpts from December 9th, 2024 PETOS

Epidemiology

• Seizures are the most common neurologic disorder in pediatrics

• 1% of children under 15 years of age have seizures

• Seizures are most common in the young and old

  • New onset seizures occur most often in those under 1 year

  • Mortality increases with age

• Febrile (fever) seizures are the most common pediatric seizure

  • Doesn’t necessarily mean they have a seizure disorder

What do we see clinically?

• Vital signs: hypoxia, hypertension then hypotension, elevated heart rate and elevated temperature.

• Labs: Acidosis, elevated k+, low glucose and rhabdomyolysis

• When intubated in the ICU, a sudden spike in HR and BP together may indicate a seizure.

In pediatrics seizures are either unprovoked or provoked (an identified cause).

There are two main types of seizures: generalized and focal.

1. Generalized seizures: These affect both sides of the brain and usually cause loss of consciousness. The person may experience shaking or stiffening of their body. This type includes:

   • Tonic-clonic seizures (formerly called grand mal), which involve stiffening and jerking movements.

   • Absence seizures, where the person may stare blankly and stop moving for a short time, often without realizing it.

2. Focal seizures: These start in one part of the brain. The person might stay awake and aware, but they may experience unusual sensations, movements, or emotions.

An important note for EMS, studies have shown that nearly 5% of patients presenting with altered mental status had evidence of non-convulsive (no motor activity) seizure status.

Febrile seizures

A pediatric febrile seizure is a brief, generalized convulsion triggered by a rapid rise in body temperature, typically in children aged 6 months to 5 years. It lasts less than 5 minutes and is not linked to neurological conditions. Febrile seizures are classified as simple (short, non-recurrent) or complex (longer, focal, or recurrent).

• Very common, frequent prompt for 911 call

• The patient will have a documented fever > or = 100.4

• Otherwise normal patient, no evidence of CNS infection

Neonatal seizures

Neonatal seizures occur in newborns and can be caused by HIE (brain injury from oxygen loss), infections, brain development issues, stroke, metabolic problems, or neonatal epilepsy.

The immature brain is more excitable due to an imbalance between excitatory (glutamate) and inhibitory (GABA) signals. Incomplete brain myelination can limit the spread of seizures in young babies.

Diagnosis is tough, as signs are subtle (e.g., lip smacking, eye deviation, stiff limbs, leg movements). 80-90% of neonatal seizures on EEG show no visible symptoms. Full evaluation (labs, CT/MRI/EEG) is encouraged for suspicion of seizure in a neonate.

Status epilepticus

A medical emergency where a person has a seizure lasting longer than 5 minutes or  or has multiple seizures without fully recovering between them. It requires immediate treatment to prevent serious complications.

The longer status epilepticus lasts, the higher the risks for:

• Neuronal injury

• Changes in brain structures and receptors

• Difficulty treating seizures

• Increased risk of recurring seizures

• Long-term issues like behavioral, developmental, and intellectual disabilities

• Acute and chronic brain damage (seen on MRI)

• Death (3% to 15% mortality rate)

Management priorities

Treatment Plan

• Open and support the airway

• Stop the seizure – give a dose of benzodiazepine

• Do not restrain; protect from injury during tonic-clonic phase

• Follow spinal motion restriction guidelines

• Avoid excessive clothing for febrile seizure patients

• Transport any child <12 months with seizure

History and Exam

• Check blood glucose (after seizure treatment or if unresponsive to benzodiazepines), temperature, and oxygen saturation

• Evaluate for toxins, overdose, or trauma

Treatment

• Preferred: Intranasal (IN) or intramuscular (IM) benzodiazepines for 1st line benzodiazepine administration

• Once IV is in place, IV benzodiazepines are appropriate

EMS will likely focus on 1st line treatment while advanced teams and hospitals may be interested in the 2nd and 3rd lines.    

Treatment goals in the adult world involve stopping the seizure, getting them stabilizable (intubated as needed) and into the CT scanner to rule out stroke. In children we may finesse things more and give more medications because there are many possible and reversible causes. We will secure the airway if we have refractory status epilepticus.

Parental education upon discharge

Especially important for new onset seizures

• No swimming alone

• No bathing alone

  • Don’t lock doors to bathroom or shower

• No driving

Protocols in practice

CME credit for this issue

News from national EMSC

EMSC Pulse

National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!

News from Utah EMSC

Meet Our Staff

PECC development

For Utah hospital and EMS Agency PECCs

PECC quarterly meeting

You will receive an invitation with the link through email. If you are a PECC and don’t receive this invitation contact our program manager, Jared Wright jaredwright@utah.gov.

When?

Tuesday, Feb 18, 2024, 10:00 AM

Southern PECC workshop

PECCs are encouraged to attend an in-person PECC workshop each year to receive up-to-date pediatric training, direction for your PECC role, and to participate in networking with other PECCs statewide. These workshops are free to designated hospital and agency PECCs. We will offer one in the northern part of Utah and one in the southern part each year.

When?

May 8th  -followed by a pediatric skills workshop for all EMS on the 9th

Where?

St. George Regional Hospital, St. George, Utah

Pediatric education from Utah EMSC

Pediatric Emergency and Trauma Outreach Series (PETOS)

PETOS (pediatric emergency and trauma outreach series)

This course provides 1 free CME credit from the Office of Emergency Medical Services, DPS for EMTs and Paramedics. The lectures are presented by physicians and pediatric experts from Primary Children’s Hospital. The format is informal; inviting questions and discussion.

Upcoming topics

January 13th, 2025 – Hangings with Stuti Das, MD

February 10th, 2025 – Gun Violence with Katie Russell, MD

02:00 PM Mountain Time (US and Canada)

Join Zoom Meeting
https://zoom.us/j/98193757707?pwd=UzdNeXppQUdtZ01KZUp2UFlzRk9vdz09
Meeting ID: 981 9375 7707

Password: EmscPCH

Archived presentations can be viewed and also qualify for CME credits. You can access them at https://intermountainhealthcare.org/for-professionals/PETOS.

To obtain a completion certificate—follow the instructions on the website

Other pediatric education for all

Pediatric Health Equity Symposium

Current Concepts in Neonatal and Pediatric Transport Con.

February 19-21, 2025

47th Annual Current Concepts in Neonatal and Pediatric Transport Conference 

https://intermountain.cloud-cme.com/transport2025

Radisson Hotel Downtown Salt Lake City, UT

*Virtual Option available

22 possible AMA and ANCC credits and Respiratory Care Credit

Children’s EM-mersion webinar series

Intermountain Children’s Health Emergency Management Team is offering a weekly (every Tuesday) 30-minute educational opportunity for all hospital-based EM’s and PECCs in Utah and the surrounding Intermountain West.

We will delve into different pediatric planning topics such as decontamination operations, reunification, behavioral health, isolation/quarantine, and more! The goal is to help you better plan for pediatric patients at your facilities!

This weekly series is designed for you to attend whenever you can—you do not need to attend all sessions.

Register here for the rotating topic schedule.

University of Utah pediatrics ECHO 2024

The Pediatrics ECHO is back! For those new to Pediatrics ECHO, you can earn CME for participating in a case-based learning session with experts in a variety of pediatric topics.

You can view previous session recordings and other programs on the Project ECHO page. CME is available for participation in these classes.

More Information

Note the University has a new EMS education website.

When? Wednesdays 12 – 1 pm (MT)

University of Utah injury prevention learning series

These offerings are quarterly.

Register here.

To view previous sessions for all these series visit this link.

Note the University has a new EMS education website.

EMS-focused education

University of Utah’s EMS trauma grand rounds

Offered every second Wednesday of even months at 2:00pm.

Click here to join

Virtual—zoom meeting

Meeting ID: 938 0162 7994 Passcode: 561313

To view archives link here https://admin.physicians.utah.edu/trauma-education/ems-grand-rounds.

Note the University has a new EMS education website.

Hospital-focused pediatric education

Primary Children’s pediatric grand rounds

Offered every Thursday, September-May

Offering both RN and MD CME

The pediatric grand rounds weekly lecture series covers cutting-edge research and practical clinical applications, for hospital and community-based pediatricians, registered nurses, and other physicians and practitioners who care for children of any age.

Every Thursday, 8 a.m. to 9 a.m. from September through May in the 3rd Floor Auditorium at Primary Children’s Hospital and at Lehi a broadcast will be held in the education center (1st floor in rooms 1 & 2).The lectures are also broadcast live to locations throughout Utah and nationwide. Click on this link to view the broadcast: https://www.youtube.com/channel/UCNQP-M_3-PdPDvnICr2Fjpg 

Connect live

Click here for the PGR PCH YouTube channel to find the live broadcast. Archives (without continuing education credit) will be posted here within 1 week of the broadcast.

Need follow up from PCH?