3yr.m. in emergency came with seizures and intermittent posturing as in photo. no h/of fever,vomiting, previous such episode. HR 156 rr 26. spo2 90 in air . after Lopez, Lopez, fosphen, fosphen seizures stopped. considering titanic spasm. ca in drip started . reverse questioning relatives said 2 times fall while playing. it was just trivial episode. after 4 hours pt stopped breathing was intubated and was put on ventilation . what do rx next

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search for the treatable cause of seizures first...like hypoglycemia or any electrolyte abnormality, renal and liver functions... for breathing you wrote 'pt stopped breathing' suggest there is no chest movement at all then it should be CNS cause...go for fundus examination and other features of raised ICT if found raised treat accordingly..

Any injury? spasms persistent?Tetanus to be considered ,work up for seizures,stoppage of breathing could b hypoxia laryngospasm or elec imbalance ,Do ionic calcium n magnesium on sample prior to Iv calcium .Neuroimaging n stabilisation to be prioritised.

Yes. in tetanus the sensorium of the patient is preserved. cbc and PT APTT should be done as an emergency step followed by Neuro imaging. intra cranial hemmorrhage can be the cause this can be an episode of febrile status..

also..
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with this scenerio it appears to be afebrile status c respiratory failure. ct ventilation c video eeg monitoring and anticonvulsant ,u still have midas drip ,levipil,phenobarbital to achieve burst suppression on eeg.monitor vitals an bp.if pupil's unequal in size den hurry for imaging other wise u can do it in next 48 hrs as pt gets stabilised.

can be CNS cause go for CT brain ideal MRI ,look for focal lesions or diffuse lesions ,h/o falls mostly point to CNS pathology, in CT if raised ICT then 3%nacl or mannitol, midline neck positioning,preventing the seizures through phenobarbital, midazolam or thiopentone infusion CT decides further management

pls rule out head injury in view of history of fall and exensor posture with respiratory insufficency after stoppage of convulsion indicating raised intracranial tension due to mass effect.needs ct scan head.earlier covulsive symptoms due to cerebral irritation followed by compressive effects

if case present with acute status epilepticus without any previous h/o seizure, no clinical symptom or sign of intracranial infection than think of autoimmune encephalitis. this may present acute catastrophic seizure. mri and csf all come normal

Status epilepticus denovo. Apart from usual cause like hypoglycemia and hypocalcaemis CNS autoimmune encephalitis should also be considered and if seizure refractory then give methylprednisolone infusion before confirmation

Also consider poisoning as it is not very common to hv cessation of respiration in a well treated case with continuous monitoring as we gen intubate when saturation is dipping dangerously

pt was shifted to govt hospital. as they denied for further treatment ct and even blood reports. the cbc .ca++ sugar was done by me and for me

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