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Seizure in a 7-year-old Boy

Poll

He is actively seizing when EMS arrives. Mother says this happens once a year, about the same time. Details, in the video.

A 7-year-old boy is in active seizure upon EMS arrival. Mother states he seizes about 1x/yr. On exam, extremities shaking, no signs of extension/flexion; aspiration sounds noted. HR, 127 bpm; RR, 30; BP, 128/59; SpO₂, 88%. Midazolam, O2 administered on site to good effect. In transit, right-sided gaze bilaterally; ALOC; GCS 4/1/1.

Your impression?

A. Seizure vs. status epilepticus
B. Aspiration
C. Trauma
D. Ascertain etiology for seizure (poor sleep, infectious process)
E. Poor compliance with anti-epileptic medications
F. Metabolic (electrolyte imbalance associated with diarrhea, if present)
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