Heres a quick survey question for you, but I would also like to know your rationale for your decision in the comment section if you have time.
Heres the scenario :
Called to a 1 year old girl, fitting. Has had previous fits and is now on anti-convulsants, although without a firm diagnosis of epilepsy yet. You arrive on scene to find her distressed, acting post ictal (confused and disorientated) but with no evidence of continued seizure activity.
She is apyrexial (doesnt have a temp), a good colour and moving all four limbs. After a short period, she appears back to normal, but Dad states that this fit was different from the others, i.e. longer and more violent. Thats enough reason for me to take her to hospital, so off we move to the ambulance. Once on the ambulance, the new paramedic I am working with states that he wants to do a B.M test on her (i.e. a blood sugar test which involves a small drop of blood being drawn from the finger or heel of the child to check she isnt hypoglycaemic (low blood sugar). Our guidelines state that all patients who have seizure activity require a blood glucose test as hypoglycaemia can sometimes cause a patient to fit.
Now, my question is this:
The child has just got settled with Dad on the back of the ambulance. Dad has just calmed down from getting the fright of his life (it’s usually his wife who witnesses the seizures whilst he is at work).You are less than 10 minutes away from the hospital, and as is their want (as I am sure is the case in most areas around the country and world), no matter what diagnostic tests we do, they will be repeated as soon as the patient enters the department, including another ‘prick’ for another drop of blood.
Do you perform the B.M test now as is stated in the ‘guidelines’, causing the little one some pain and likely to distress her again (bearing in mind she does not show any clinical signs of hypoglycaemia), or do you leave off and wait for the hospital to it if they require.
I really dont think there is a right or a wrong answer to this. It comes down to clinical judgement based on the assessment of the child. The guidelines we use are just that, ‘guidelines’. We dont have protocols anymore.
Im curious to hear youre rationale for your decision. Please leave a comment.