Febrile seizure in a child at a school carnival

Patient Information

Dispatch: You are called to the FAP at Riverside Primary School Spring Carnival. A parent has carried in an 8-year-old girl (Mia Cartwright) who had a shaking episode at the jumping castle. She is now drowsy and the parent is very distressed.
Patient: Mia Cartwright — 8yr (25kg)
Incident History: Mia was at the jumping castle when her mum noticed she suddenly went stiff and started shaking for approximately 2 minutes. Shaking has now stopped. She has been unwell with a cold and runny nose since yesterday.
Emergency Contact: Sarah Cartwright (Mother) — 0412 847 391

Initial Rapid Assessment

Response: Voice
Airway: Patent. No airway obstruction. No stridor. Mouth clear — no vomit or secretions noted.
Breathing: Breathing spontaneously. Unlaboured. Mild increase in rate. No accessory muscle use.
Circulation: Radial pulse present, regular, slightly elevated rate. Skin warm and flushed. No active bleeding. CRT 2s.
Disability: GCS 12 (E3V3M6). Drowsy, confused, not orientated to time, place or person. Post-ictal state. Pupils equal and reactive to light.
Exposure: No rash. No visible injuries. Skin warm and dry to touch. No urticaria or wheals.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	22	118	96/60	2s	12	3 3 ++	38.9	5.4 mmol/L	–
10 mins	99% (O2 simple face mask 6L/min)	Nil	18	106	98/62	2s	14	3 3 ++	38.9	5.4 mmol/L	–

History Taking

Treatment Response

Diagnosis

This patient is suffering from a febrile seizure, now in a post-ictal state, with an underlying febrile illness (likely viral upper respiratory tract infection).

Facilitator Triggers — if trainees miss a critical step

! (If trainee does not place Mia in the lateral position immediately on arrival — Mia begins to produce excess secretions and there is a risk of airway compromise. Prompt the trainee: 'Mia is making gurgling sounds.')
! (If trainee does not obtain a BGL — facilitator prompts: 'The mum asks you if low blood sugar could have caused the shaking.')
! (If trainee does not measure temperature — facilitator prompts: 'Mia feels very hot to touch. The mum mentions she had a warm forehead this morning.')
! (If trainee attempts to place an OPA in a patient who is responding to voice and showing signs of gag — facilitator prompts: 'Mia grimaces and gags when you attempt to insert the airway adjunct. What do you do now?')
! (If trainee does not monitor persistently for a second seizure — at 8 minutes, have Mia briefly stiffen and eye-roll for 5 seconds then settle, requiring reassessment and updated documentation.)

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — confirm airway patent, no active seizure, spontaneous breathing.
3 Position Mia in the lateral position to maintain airway and allow drainage of secretions.
4 Prepare suction equipment and have it at bedside — suction only if secretions present and airway at risk.
5 Apply SpO2 monitoring and assess pulse oximetry.
6 Administer Oxygen via simple face mask at 5–8 L/min, titrating to maintain SpO2 ≥95% in paediatrics. Confirm 6 medication rights: right patient, right drug, right dose, right route, right time, right documentation.
7 Obtain full Vital Signs Survey: GCS, BGL, SpO2, RR, HR, BP, Temperature.
8 Record BGL — result 5.4 mmol/L, within normal range, no glucose gel required.
9 Record tympanic temperature — result 38.9°C, consistent with febrile illness.
10 Perform Secondary and CNS Survey once seizure has terminated and patient is stable.
11 Obtain SAMPLE history from mother: no known epilepsy, no prior seizures, febrile illness since yesterday, no medications, no allergies.
12 Do NOT actively cool Mia by sponging — this will increase temperature via shivering.
13 Do NOT attempt to force an airway adjunct into the patient's mouth if she is responsive and showing a gag reflex.
14 Monitor persistently — repeat full observations every 10 minutes.
15 Assess for recurrence of seizure activity throughout the scenario — if recurrence, protect from injury, maintain lateral position, reassess airway.
16 Reassure and de-escalate the distressed mother — explain what a febrile seizure is in simple terms and that Mia is being monitored.
17 Recognise this seizure was approximately 2 minutes duration (not prolonged >5 minutes) — call CSP for ambulance support given paediatric seizure and post-ictal state — CSP determines response priority.
18 Request ambulance and prepare for IMISTAMBO handover.
19 Document time of seizure onset, duration, and post-ictal observations in patient care record.
20 Scenario ends on arrival of ambulance and IMISTAMBO handover.
21 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Seizures · Oxygen Delivery · Blood Glucose Monitor · Tympanic Thermometer · Lateral Position · Suction · Oropharyngeal Airway · Primary Survey · Secondary & CNS Survey · Glasgow Coma Scale (GCS) · Pulse Oximetry

How did you go?