Neurological

Febrile seizure in a child at a school carnival

Foundation

Pediatric · 8yr · male

Patient Information

Dispatch	You are called to the first aid tent at Riverside Primary School Autumn Carnival. A parent has brought in an 8-year-old boy (Lachlan Dempsey) who had a brief shaking episode near the jumping castle and is now drowsy and confused.
Patient	Lachlan Dempsey — 8yr (26kg)
Incident History	Mum says Lachlan was running around at the carnival when he suddenly went stiff then started shaking for approximately 2 minutes. He has stopped shaking and is now drowsy. Mum states he has been unwell since this morning with a fever and runny nose.
Emergency Contact	Sarah Dempsey (Mother) — 0412 447 893

Initial Rapid Assessment

Response	Voice
Airway	Patent. Nil airway obstruction. Nil secretions visible. Nil stridor.
Breathing	Breathing spontaneously. Slightly increased rate. Nil audible wheeze or stridor.
Circulation	Radial pulse present, regular, slightly elevated. Skin warm and flushed. CRT 2s. Nil active bleeding.
Disability	GCS 12 (E3V4M5). Disoriented to time and place. Drowsy but rousable to voice. Post-ictal state.
Exposure	Nil rashes. Nil visible injuries. Skin warm and dry. No incontinence noted.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	96% (RA)	Nil	22	118	96/60	2s	12	4 4 ++	38.9	5.4 mmol/L	2
10 mins	98% (O2 simple face mask 6L)	Nil	18	108	100/64	2s	14	4 4 ++	38.9	5.4 mmol/L	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from a febrile seizure (post-ictal phase) in the context of an underlying febrile illness (URTI), now in a post-ictal drowsy state with no ongoing seizure activity.

Facilitator Triggers — if trainees miss a critical step

! (If airway is not assessed and patient is not placed in the lateral position within 2 minutes, Lachlan begins to snore and oxygen saturation drops to 92% on room air — prompt trainees to reposition and reassess airway.)
! (If BGL is not checked within the first assessment cycle, facilitator advises trainee that Lachlan's mum is asking 'is his blood sugar okay?' — prompt BGL assessment.)
! (If temperature is not taken and documented, mum asks 'does he have a fever?' — prompt tympanic temperature assessment.)
! (If seizure recurs during scenario — lasting >5 minutes — trainee must manage as per Seizures CPG: protect from injury, maintain airway, apply oxygen, note start time, and prepare for Priority 1 transport with pre-notification.)

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey: confirm airway patent, assess breathing and circulation.
3. Position Lachlan in the lateral position — post-ictal patient with GCS 12, airway protection required.
4. Apply oxygen via simple face mask at 6 L/min — titrate SpO2 to target ≥95% for paediatrics.
5. Perform full Vital Signs Survey: GCS, BGL, SpO2, RR, HR, BP, temperature.
6. Obtain BGL — result 5.4 mmol/L, no treatment required for hypoglycaemia.
7. Obtain tympanic temperature — result 38.9°C, confirms febrile illness.
8. Assess pupils — PERL 4mm bilaterally.
9. Take IMISTAMBO history from mum: confirm seizure duration (~2 minutes), no prior seizure history, current febrile illness, nil medications, NKDA.
10. Monitor patient persistently — repeat vital signs every 10 minutes.
11. Do NOT actively cool Lachlan by sponging — this may cause shivering and increase temperature.
12. Reassess GCS at 10 minutes — improving to GCS 14 expected as post-ictal phase resolves.
13. Reassess for seizure recurrence throughout scenario — if seizure recurs and lasts >5 minutes, treat as time critical and arrange Priority 1 transport with pre-notification of receiving facility.
14. Complete Secondary and CNS Survey once seizure has terminated and patient is stable.
15. Arrange transport to hospital for medical review — all paediatric febrile seizures require ED assessment.
16. Scenario ends on arrival of ambulance and IMISTAMBO handover.
17. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Seizures · Hypoglycaemia · Primary Survey · Oxygen Delivery · Tympanic Thermometer · Blood Glucose Monitor · Lateral Position · Glasgow Coma Scale (GCS)

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Signs/Symptoms	Drowsy and confused post-seizure. Warm and flushed. Mum reports shaking of all four limbs lasting approximately 2 minutes followed by unresponsiveness then gradual improvement.
Allergies	NKDA
Medications	Nil regular medications
Pertinent History	No known seizure disorder. No prior febrile seizures reported by mum. Was seen by GP 2 days ago for upper respiratory tract infection. No meningism symptoms reported.
Last Oral Intake	Ate a sausage sizzle approximately 1 hour ago. Drinking water throughout the morning.
Events Leading	Was running and playing at the carnival jumping castle area when he suddenly stopped, went rigid then began shaking. Mum was present throughout.
Treatment Prior	Mum placed Lachlan in the recovery position after the shaking stopped. No medications given.

Onset	Seizure occurred approximately 10 minutes ago. Has been unwell since this morning.
Pain	Nil pain reported. Rates discomfort 2/10 on prompting — generalised headache.
Quality	Generalised tonic-clonic movements observed by bystanders. No focal features reported.
Radiates	Nil
Severity	2/10