My baby is seizing! OSCE by Michael

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

You have just seen Lily, a 14-month-old girl. She had what sounds like a typical, uncomplicated, febrile seizure, lasting 2 minutes, before self-terminating. Her parents called the ambulance who recorded a normal BSL.

Lily was home sick from childcare and had a temperature of 39ÂșC measured after the seizure, but is now afebrile. On examination, she looks well and has signs and symptoms of an URTI.

Instructions for the candidate

You are the consultant on. You have examined Lily, which was normal with only symptoms of URTI, and are now talking to her mother, Anne. You are to gain further history and then provide a diagnosis and management plan.

Domains being examined

  • Medical Expertise
  • Communication
  • Health Advocacy
  • Professionalism
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Lily is your first and only child thus far. She was kept home from childcare for viral URTI symptoms. She was playing on the bed, then went quiet. you witnessed her go stiff and blank and then begin to convulse, with both arms and legs involved. You called for your husband to help and then called the ambulance. By time the ambulance arrived the seizure had ended, lasting less than 2 minutes. She was drowsy for about 5 minutes and flat for about 30 minutes after that, but has returned to her normal self, if a little woeful.

Lily has no medical problems, medications or allergies. She was born vaginally at term. She is up-to-date with immunisations.

There is no family history of epilepsy or seizures. One of her uncles may have had a febrile convulsion when a baby.

You are quite shaken after this frightening experience. You wonder if it is normal or a sign that something is very wrong. You ask "Will it happen again?" "Does this mean she has (or will get) epilepsy?" "If we have other children, will this happen too?" "Will this happen every time she gets a fever?"

For the examiner

None

Domains Assessment Objectives

Medical Expertise
Expertise regarding febrile convulsions

Communication
Clear explanations and relaying of information

Health Advocacy
Clearly describing how to manage fever and markers of sinister seizures

Professionalism
Acknowledge and respond to parent's anxiety and concerns

Other Assessment Notes

1. History
- Details of event - preceding, seizure, post-ictal
- Past medical history
- Medications
- Family history

2. Explanation of febrile seizure
- Clearly explain is common and benign condition
- Explicitly state is not epilepsy (may have slightly higher risk in future)
- Provide estimates for incidence and for recurrence (~3% incidence, 33% recurrence)
- Outline markers of complicated febrile convulsion (>15 mins, >1 in 24 hours/per fever, complex seizure, neuro deficit)

3. Further management
- Investigation of fever (if on ABx, medical admission required for underlying infection or fever PUO)
- Fever management (remove clothing, tepid bath, antipyretics) - acknowledge this may not change likelihood of febrile seizure
- Discharge criteria (simple seizure, neuro normal, well, sensible parents will cope, access to healthcare) or offer admission for observation
- Safety net - when to return


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