Is this an emergency urgent or routine clinical condition

Clinician must determine if care needs to be administered emer-gently. An emergency case requires the same attention to detail as a routine case; however, the pace and order in which actions are completed differs. Remember the ABCs (airway, breathing, circulation).

B. What are the associated symptoms? Depending on the location of the electrical discharge, a variety of clinical phenomena can be manifested, including GI symptoms (nausea), fear, unusual sensations (eg, hallucinations), localized motor or sensory activity, or autonomic changes (heart rate and BP alterations). Associated symptoms can also give clues to underlying etiology. Diarrhea, for example, can be a clue to shigellosis.

C. Does patient have a history of similar episodes? If patient has had similar events in the past, it is much less likely that this is an urgent medical or surgical condition.

D. Did patient lose consciousness? There are two basic types of seizures: generalized and partial. Generalized seizures present with sudden onset of loss of consciousness, because they are a manifestation of widespread abnormal electrical discharges involving both hemispheres. Partial seizures are due to a localized abnormal electrical discharge and no loss of consciousness occurs. Partial seizures can secondarily generalize.

E. What is the clinical description of patient's seizure or episode of inattention? How long did event last? What time did it occur (daytime, during sleep)? Were there any associated activities, such as movements of face or body? What was child doing before and after episode (eg, interrupted speech)? Were there any precipitants to episode? One type of generalized seizure—absence seizures—classically presents with staring spells. These seizures typically last < 30 seconds and have no associated alteration of arousal before or immediately after the event. Staring is also a common manifestation of a complex partial seizure. Complex partial seizures typically last 1-3 minutes and may be followed by an alteration of arousal (postictal state).

F. Pertinent Birth, Medical, or Family history. Many situations, including prematurity, developmental delay, underlying neurocutaneous disorders, cocaine use, intracranial bleeding, and family history of epilepsy, place children at risk for nonfebrile seizures.

1. Birth history. Did mother receive prenatal care? Was there any history of maternal medication use or substance abuse during pregnancy? Were there any maternal medical complications during pregnancy? Was pregnancy completed to term? Were there any complications during delivery?

2. Medical history. Were developmental milestones achieved at appropriate ages? Is there any significant medical or surgical history? Does patient take any medications? Is there a history of head trauma?

3. Family history. Is there any family history of neurologic disorders?

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