379.A 15-month-old girl is brought to the ED by EMS secondary to
seizure activity noted at home. The patient is a previously well child. Her
immunizations are up to date. The patient is reported to have had a fever
for the last 2 to 3 days. She has had no cough, congestion, vomiting, diar-
rhea, or rash. Her urine output is appropriate. After defervescence she seems
to act appropriately and feed well. This afternoon, the patient was being
observed in the playroom when her eyes rolled back and she began having
generalized tonic-clonic activity that lasted for approximately 2 minutes.
When EMS arrived, the patient was in her mother’s arms, tired but rousable,
and in no apparent distress. On examination, the temperature is 103°F, H R
155 beats per minute, RR 32 breaths per minute, and BP 85/50 mm Hg. She
has red tympanic membranes with no fluid and good mobility, oropharynx
clear, lungs and heart examinations are normal, and abdomen is soft and
nontender. Skin examination is clear with brisk capillary refill. Over the
course of your evaluation, the patient becomes increasingly interactive, well-
appearing, and playful. Which of the following is the most appropriate
course of action for this patient?
a. Obtain complete blood count (CBC), blood culture, urinalysis, urine culture,
chest radiograph, and determine treatment on the basis of the results of these
tests.
b. Obtain blood and urine for culture, administer ceftriaxone, and discharge home.
c. Obtain catheterized urine specimen for analysis and treat as outpatient if urinalysis
is suspicious for infection.
d. Obtain routine blood work and head computed tomographic (CT) scan and call
for neurology consultation for first-time seizure.
e. Obtain head CT scan and perform lumbar puncture secondary to fever and
seizure to rule out meningitis.
406 Emergency Medicine