Tuesday, February 19, 2013

When things go bonk, call the ambulance: post trauma seizure

Actually, make that a loud THWACK!

Followed by screaming.  Which is good.  Probably not too injured.

Followed by sudden stiffening, back arching, choking, and turning a lovely shade of eggplant.

Add in a massive grand mal seizure.  That lasted for an eternity 30 seconds.


Er, not so good.  Possible brain injury?  A brain bleed?  spinal injury?


That is exactly what happened this past Thursday (yes, Valentine's Day) afternoon.  I would like to tell you that it all happened in slow motion, but it didn't.  It was fast.  Very fast.  Miss Leslie and I were in the kitchen with Ellie getting ready to begin our ABA therapy session.  Ellie was being her usual self.  Climbing.  She always climbs.  She is surefooted.  The climb wasn't the problem.  The climb didn't cause the fall.  What caused the fall was Ellie thinking that she could dive off the side of her booster chair and not get hurt.  She still thinks that she is invincible.  Or that she is made of rubber and will bounce.

This is the evil, horrible chair that she fell from (estimated that she fell 4 feet).

Oh  why did we have to have a taller than average kitchen table and chair set?

Miss Leslie and I watched in horror as she turned to the side and started to lean precariously over the edge of the booster seat.  Almost as though she wanted to look under the chair.  Or dive into a swimming pool.  I was right there.  Right in front of her.  I knew it was going to happen and I was not fast enough.  I wasn't able to stop it.  I wasn't able to protect her.

Toddlers are top heavy.  She catapulted off the side of the booster and somersaulted.  The Bear did a flip alright.  It was not graceful and her landing sucked.  Big time.  She fell about 4 feet and hit the back portion of her head and lower back on a very hard Brazilian Walnut floor (this is a 0.5 inch floor of solid wood so it was hard).  She immediately cried which is usually a good sign.

The thing is, Bear has fallen before.  All kids fall.  Usually, Ellie doesn't really cry.  She just gets pissed off that I am holding her and thus preventing her from re-climbing whatever dangerous thing she was scaling be it the cabinets, bookshelf, or the wall even.  This was different.

She screamed and screamed.  I was cradling here.  Holding her.  I knew it was big fall, but I didn't think it was that big.  I wasn't worried.  I figured she would bounce back.  Until, she suddenly arched back and started making choking noises.  Gasping.

She turned blue and started to rhythmically jerk.  Her full body.  She was arched back so I couldn't see her eyes.  I look at Leslie with shock.

Shocked Mama Bear: "Is she?"

Shocked Miss Leslie: "yes. yes she is.".

I lay my daughter onto the floor and try to stabilize her spine.  My heart is beating so fast that I am certain it will explode.  Leslie is on the phone with 911.  They are asking for my address.  I stared blankly at her.  I said something.  I think I gave the correct street address, but I also think I gave my old zip code.  The one in Philly.  There is a reason that they do not let healthcare providers treat family members.  All reason goes out the window.

I was getting pissed off---can't they trace the call?  Can't they find us?  My baby is injured.  Seriously injured.  Pissed off and panicked, I was obsessively checking my little girl's pupils.  Perfect, they were perfect.  She had resumed screaming.  That's a good sign.  Right?  Right?!?!?!

Andrew!  I needed to let Andrew know!  Except, the one time my hubby forgets his cell phone was that day.  On the freaking kitchen table.  I frantically text his work buddy:

Andrew now. ellie fall seize 911 ambulance.

Thanks goodness, TC was working at home.  Thank goodness, TC found my hubby.  Thank goodness, TC and hubby understood my shorthand.  Andrew was headed home.

While waiting an exceedingly long time for the ambulance that was just literally around the corner from us, Ellie waved.  Yes, she waved to the ambulance.  Whew!  It was going to be okay.

Then I opened my mouth and started speaking medical jargon.  Let me tell you how much that throws off EMS.  More on that later.  They asked me for her carseat.  I bewilderly thought "oh crap, they they they expect me to drive her to the hospital.  They are leaving us?!?!"  I suppose my panic showed because they calmly explained that they needed to the carseat to help place her in C-spine precautions.  I just gaped.

Confused & Dazed Mama Bear: Carseat.  Yes yes, the carseat.  Very good.  

Freakishly Calm EMS: Mam, the carseat?

Lost.  I was completely lost.  I couldn't figure out where the carseat was.  Or how to even tell Leslie to get to it.  I just mutely handed my keys to Leslie and muttered something about garage and car.

After finally getting The Chunky Chicken into the ambulance, my husband shows up.  Yeah, that is how slow EMS is folks.


EMS had to get a little inventive with the C-spine stabilization

The entire ride to the ER was nerve wracking.  Ellie was all bundled into the stretcher and the pulse ox will not pick up her oxygen sats or her heart rate.  I finally reapplied the pulse ox myself and bingo, baby girl was satting just fine at 96% yet her heart rate was high.  She had a flat affect.  Just staring.  She was silent. Gone were her screams.  I longed to hear those screams.

She started having absence seizures.

I was holding her tiny hand so tight it was turning purple.  I was calling out "Ellie, it is mama" and waving my hand in front of her face.  She just stared with the left side of her lips twitching upward.

Then, she would be back with us and wave to the cars she could see out the ambulance back window.  She continued to have these absence seizures the entire ride there, but when she would come out of these episodes, she would say her name is "E" and wave to the cars.  Pupils looked great.  She was breathing.  She was moving her arms and legs.  Yet, she wasn't herself.

Visions of her eyes rolling back, or a blown pupil, or having to perform CPR danced through my head.  Why hadn't that EMS guy put an IV in her arm?  Why is he just sitting there? I wished I wasn't a healthcare provider.  I wish I never worked that stint in a PICU.  I know too much and I jump to worst case scenario.  Thankfully, my worries came to naught.


You guessed it.  She is contemplating climbing over that stretcher railing.
How do I know?  Because she tried too as soon as they took the neck collar off of her.

Bear's case was considered non-urgent because she was breathing, awake, and not bleeding (these are good things!.  We waited over an hour for the doc to even come in.  Another hour to get the CT scan of her head and neck.  Two more hours to get the results.  Thirty more minutes after we were told we were going home to get the discharge paperwork.

During that time, in the beginning,  Ellie continued to have a few more episodes in which she would have eyes shifting to the left coupled with lip smacking or the left side of her mouth twitching.  They grew further and further apart until she had none the last 2 hours.  The ER doc was adamant at first that she must have an underlying seizure disorder until I mentioned she had a clean EEG performed by Dr. G a few months ago after a febrile seizure/meningitis scare.  He finally conceded that these absence seizures were probably related to the fall given that they decreased and then stopped all together.  Yet he did advice that we watch her closely.

The ER doc unstrapped the C-spine collar and asks Ellie to walk.  The stinker turns right around and climbs the chair and then the stretcher.  Andrew and I were told that she is fast.  All I knew was that my Bear, who just aged me 20 years, was fine.  She was just fine.

48 hours after injury.



This is the end of Part 1.  Part 2 will cover the following:

Post Traumatic seizure: Which came first?  The seizure of the fall?

How do you know when to proceed to the ER after a head bonk?

C-Spine: Down syndrome and AAI

Why it is important to include Down Syndrome in your list of past medical history.



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42 comments:

  1. Your story just aged ME 9 years. Am so, so relieved she's fine. Big hugs.

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    1. Only 9 years, huh? Thanks for the hugs. This child is back up to her antics and I am ever so grateful for that! Her guardian angel never gets a break.

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  2. Oh my goodness! I'm so glad she is ok!! How incredibly scary! A Valentine's to never forget... Looking forward to your Part II post, esp knowing when to go to ER. Hang in there!

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    1. Nothing screams romance like a pediatric ER. I need to get cracking on Part 2. Ellie has had her fair share of head bonks but this is the first one where we had her looked at--obviously turning blue and seizing necessitated an evaluation. It is amazing how fast she bounced back

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  3. Wow! Glad Ellie is ok. I am sure you were terrified! She looks great in the last pic ��!

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    1. Amber, so terrified. I thought I was going to puke in the ambulance because I was so scared. Ellie is completely back to her normal self. I never thought that I would be so relieved to have her all hyperactive again!

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  4. I'm so glad things turned out so well. I was in tears just thinking about how horrible it could have gone. And I agree, it is so much worse when you know just how bad it could get. Give that cutie extra hugs and kisses. And bubble wrap!

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    1. Will do! I slept with Ellie that night. I had to wake her every 1-2 hours and she was getting annoyed with me. I just snuggled with her and held her so close.

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  5. Yikes!!! I was have been so terrified, too! I am so glad she is back to her normal antics. =) What a relief!

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    1. A relief for sure! Ellie certainly is spunky!

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  6. Ok, I just hyperventilated reading that!!!! I am soooo glad that everything is okay!! How terribly frightening.....I can't even imagine! Huge hugs, mama!!!!!

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    1. Thanks, Karrie! I aged abut 20 years or so. Fortunately Andrew did witness it or he would have aged even more! Ellie sure likes to push boundaries and has no fear. I am ever so grateful that she is okay. That things turned out the way they did.

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  7. Oh no!! That sounds terrifying. So glad she's ok!

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  8. Unbelievable. Man, oh man, I can't even IMAGINE how terrifying that must've been. :-( Had to laugh about you forgetting your address...I did that once when I had to fill out paperwork before my wisdom teeth extraction when I was in college. I had just finished reading all the waiver forms stating all the crazy stuff (including death) that could happen during the surgery and I suddenly spaced out when it asked for my details. I had to fish my license out of my wallet to find my address! Funny what the brain does in high-stress situations like that...

    Btw, off topic, how do you get the comments that allow you to "reply" in Blogger? I can't do it. Is it because I have my comments open up in a new window? PM me...

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    1. Becca, sent you a PM. For all of those bloggers out there who are wondering about the comments--go to settings and then click on comments. At the drop down box, select "embedded"

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  9. I just totally stressed out reading this... one of my worst nightmares. Thank goodness she is ok. I don't know how you didn't just faint, but I guess when these things happen so fast you just deal with it, and feel the crazy rush afterward.

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    1. TUC, I didn't mean to stress you out! A nightmare for sure but it could have been so much worse. Oh the things that were racing through my mind. Sometimes I wish I never had medical training. Still feeling that crazy rush. . .!

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  10. OMG!!!! What a scary, terrifying, horrible thing to have to see, and go through!!!! I hope that Ellie Bellie is doing ok today!!

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    1. Oh Anna, she is spunky as always. She is a live wire. That being said, given how she was on Thursday, I am rejoicing that she is up to her usual antics.

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  11. oh my goodness. i am so glad she's okay! my little one (my first and only, whom also happens to have down syndrome) is just coming up on six months and is as squirmy as can be. i know the moment he figures out how to crawl (and it will be soon, i'm very sure, and so is he) i will be running after him around my house hawk-eyeing his every move. i'm not ready for this phase yet!

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    1. Hi Kelsey, you are in for an adventure! Get down on his level and then baby proof anything that looks remotely interesting. You will be amazing at how the kiddos can bypass those child-proof locks!

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  12. Oh. My. Goodness. Thank you for sharing, and I will read your follow-up with eagerness... my son fell down a very tall, very long, very uncarpeted flight of stairs and it was such a hard fall, we too called 911. He had no seizures, but your post has made me realize there's always next time.

    Phew. I'm exhausted!! What a horrible experience for you, and so perfectly described in this post.

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    1. Yikes! I would have had a hear attack! It is taking me forever to write my follow-up. I am only 1/4 of the way through. I tend to be long-winded when it comes to medical stuff :-) Anyway, I am glad that your little boy is okay. Stairs scare me.

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  13. Oh poor sweet baby girl! I hate seizures. Just the word itself gives me the chills. Im so glad that she bounced back but what a horrible way to spend Valentine's Day!

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    1. Seizures are always scary to me. Whether they be the full on muscle jerks or the staring ones. They are hard to watch because the person just isn't there. Eh, we celebrate Valentine's Day the follow day. Bear had gotten so much candy from school! Seriously, it was like Halloween!

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  14. Oh Anna! I'm in tears!!!! Little Ellie!!! Hugs to you both- I'm so grateful she is okay. What a horrifying experience for you both. Thank you so much for sharing and reminding us to look for post fall issues. My heart was racing reading this. Beautiful Ellie!! Hugs to you both!

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    1. I was reading some article the other day about a traumatic brain injury from a fall. I saw the picture of the 11 you boy. He was intubated and had wires everywhere. He had to relearn how to talk and walk. He is okay now but that picture made my heart contract. I know how lucky we were and I am so thankful.

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    2. Obviously not a boy over here. But I know how that feels. My mom has a picture of me in the hospital at age 12. I'd had a lot of seizures and a stroke due to brain swelling. They brought the therapy dogs in and I was so happy but you can't tell because one side of my face is paralyzed and the other is really swollen. I spent 5 months relearning how to use the left side of my body.

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    3. Obviously not a boy over here. But I know how that feels. My mom has a picture of me in the hospital at age 12. I'd had a lot of seizures and a stroke due to brain swelling. They brought the therapy dogs in and I was so happy but you can't tell because one side of my face is paralyzed and the other is really swollen. I spent 5 months relearning how to use the left side of my body.

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    4. Madelynn! How terrifying! You must have been both scared and frustrated. I just cannot imagine.

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  15. Sadness!!! Glad to hear the rockstar is back on her feet. Seizures are never fun. I had five grand mal in a row once.

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    1. Oh my goodness! Do you know when you are going to seize? Like an aura or something? Do you remember the seizure afterwards?

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  16. Sadness!!! Glad to hear the rockstar is back on her feet. Seizures are never fun. I had five grand mal in a row once.

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  19. Holy moly scary. So glad she is ok. So crazy how quick things can change. Tell that little monkey to keep her 2 feet on the floor, ok?? (if only it were that simple! ;))

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    1. Chunky Chicken insists on climbing. . . If I say "feet on floor" she listens but then it is right back to climbing. Some of it is her motor sensory issues. She is driven to climb. Fortunately, she is sure-footed most of the time. Sadly, it is her curiosity--ie the leaning over the side of the booster chair to look under it that caused her fall. Toddlers I think are meant to keep us on our toes!

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  20. You had me in tears... so scary. So glad she is ok!

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    1. Thank you, Liz! Ellie keeps us on our toes.

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  21. Oh my goodness Anna, I would have been terrified if I was you. I am so glad you have nursing training and knew what to do and what to say/ask!!! I'm happy Ellie is ok. Poor little thing.

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    1. Thanks, Se Se! I was terrified! I still am when I see her climb something lightening fast and gets ready to try something like a nose dive or a flip or some other thing she should not be doing. She is fearless. Absolutely fearless and I am not fast enough :-/

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