Emergency Management of Febrile Seizures: Clinical Assessment and First Aid Interventions in Prehospital and Emergency Settings

Abstract

Background: Febrile seizures are the most common neurological disorder in early childhood, affecting children between 6 months and 5 years of age. They are convulsive events associated with a fever, distinct from intracranial infections or pre-existing epilepsy, and while generally benign, they are a frequent cause of caregiver anxiety and emergency department visits.

Aim: This article aims to outline the evidence-based clinical approach to febrile seizures, focusing on accurate diagnosis, acute management, and appropriate diagnostic workup to distinguish simple from complex presentations and rule out serious underlying conditions.

Methods: A comprehensive review of the etiology, pathophysiology, and classification of febrile seizures is presented. The evaluation and management strategies are detailed, emphasizing a thorough history and physical examination to guide selective use of diagnostic tests such as lumbar puncture, electroencephalogram (EEG), and neuroimaging. First-line pharmacological interventions for prolonged seizures are also discussed.

Results: The majority of febrile seizures are simple, self-limited, and require no specific treatment beyond identifying and managing the underlying febrile illness. Complex febrile seizures (prolonged, focal, or recurrent within 24 hours) warrant a more extensive evaluation to exclude serious pathologies like meningitis or structural abnormalities. Rescue benzodiazepines are effective for aborting prolonged seizures in prehospital and emergency settings.

Conclusion: The management of febrile seizures is primarily supportive and focused on reassurance. A structured, interprofessional approach ensures safe, effective care, minimizes unnecessary interventions, and provides crucial education to caregivers.