Neurological

Febrile seizure in a child at a school carnival

Foundation

Pediatric · 8yr · female

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.
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) — Priority 1 transport criteria not yet met but ambulance should be requested given paediatric seizure and post-ictal state.
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

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Signs/Symptoms	Drowsy and confused following a tonic-clonic shaking episode lasting approximately 2 minutes. Now in post-ictal state. Warm and flushed skin.
Allergies	Nil known allergies.
Medications	Nil regular medications.
Pertinent History	Has been unwell since yesterday with a runny nose, sore throat and low-grade temperature. No prior seizure history. No known epilepsy. No head injury. No recent overseas travel.
Last Oral Intake	Ate a sausage sizzle and had a juice box approximately 1 hour ago.
Events Leading	Mia was playing on the jumping castle with friends. Mum noticed she suddenly stopped moving, went rigid, then began shaking. Mia fell to the side and mum caught her. Shaking lasted about 2 minutes then stopped and Mia became limp and drowsy.
Treatment Prior	Mother placed Mia on her side after the shaking stopped. No medications given.

Onset	Seizure commenced suddenly approximately 5 minutes prior to EHS arrival. Mum reports Mia stiffened then shook for around 2 minutes before going floppy and becoming drowsy.
Pain	Nil reported — patient unable to reliably self-report due to drowsiness.
Quality	Generalised tonic-clonic episode per mum's description — whole body involvement, eyes rolled back.
Radiates	Nil
Severity	Nil pain score obtainable at this time.