Febrile seizure in a child at a school carnival

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 urgent ambulance support via CSP — IMISTAMBO handover.)

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 urgent ambulance support via CSP — IMISTAMBO handover to CSP.
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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