Seizures



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Seizures
Inclusion Criteria
  • Patient presenting with ongoing seizure activity
Exclusion Criteria
  • Age < 1 month

Notify PICU and Neurology

2nd Medication:

Levetiracetam: 50 mg/kg, max 2500 mg

OR

Fosphenytoin: 25 mg/kg

3rd Medication:

Phenytoin: 25 mg/kg

OR

Valproate: 40 mg/kg

OR

Levetiracetam: 50 mg/kg

Ongoing Monitoring and Assessment:

  • Continually assess O2 status
  • Frequent BP checks (q5min) while loading with medications
  • Brief H&P

ADDITIONAL WORKUP

1. To consider CT:

  • Focal neurologic findings
  • History of trauma (or concern for NAT)

2. To consider Lumbar puncture:

  • Febrile
  • Concern for meningismus

IMMEDIATE MANAGEMENT:

  • ABCs, Oxygen, Monitor
  • IV access, Glucose POC
  • Initial labs - CBC, CMP, Mg, Phos, HCG, tox screen, anticonvulsant levels as indicated

References:

Brophy GM, et al. Guidelines for the Evaluation and Management of Status Epilepticus. Neurocrit Care 2012; 17(1): 3-23.

Chamberlain JM, et al. Lorazepam vs diazepam for pediatric status epilepticus: A randominized clinical trial. JAMA 2014; 311: 1652-1660.

Glauser T, et al. Evidence-based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Currents 2016; 16: 48-61.

1st Medication:

If IV access:

  • 0.1 mg/kg IV Lorazepam, max 4 mg
  • Prepare 2nd dose of IV Lorazepam. Administer within 5 minutes if continuing to seize.

If no IV access:

  • Consider buccal or intranasal Midazolam (0.2 mg/kg, MAX 10 mg)