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2. You are called to the Emergency Department to admit a 2-year-old patient who had a 2 minute generalized tonic-clonic seizure associated with fever. The patient is well-appearing and at baseline neurological status 30 minutes after the event. His neurological examination is normal. What should you do?

A. Discharge the patient home after seizure education
B. Admit the patient to the floor for overnight observation
C. Recommend the Emergency Department obtain a head CT
D. Obtain screening labs including a CBCD, chemistry panel and CRP
E. Discharge the patient home with rectal diazepam.

1 Answer

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Final answer:

The appropriate action for a 2-year-old patient post-febrile seizure with a normal neurological exam may be to discharge with caregiver education on seizures, without immediate extensive investigations unless indicated by clinical protocols or risk factors.

Step-by-step explanation:

Given the scenario of a 2-year-old patient who had a 2-minute generalized tonic-clonic seizure associated with fever and is now well-appearing with normal neurological status 30 minutes post-event, the best course of action would vary depending upon specific clinical guidelines and the physician's clinical judgment. One possible approach, especially considering the patient's rapid recovery and normal neurological exam, could be to discharge the patient home after providing thorough seizure education to the caregivers. This education would cover seizure safety, when to seek further medical help, and the signs of serious complications. Additional investigations such as electroencephalography (EEG), head CT scan, or blood tests might be considered based on clinical protocols or if they are deemed necessary due to certain risk factors or an irregular clinical presentation. For a simple febrile seizure, though, extensive testing is not always indicated in the emergency setting. The administration of rectal diazepam would typically be reserved for acute seizure management rather than as a take-home medication unless the child has a known seizure disorder with a pre-established seizure plan that includes intervention with rescue medications.

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