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.



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.



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.