Status Epilepticus: Management

by Brian Alverson, MD

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    00:01 If you see a patient who you suspect is having a seizure what you do? Well, the first thing we have to remember is how much time it's been going on It's key to ask the question is: When did it start?" Remember, it takes at least 35 probably 45 minutes baby or child is going to have brain damage from continuous seizing.

    00:24 The first thing you should do if you encounter a patient seizing is take your own pulse.

    00:29 Calm down.

    00:30 You have some time.

    00:32 It's not a rush or an emergency and is the first thing I see students do on the wards as they get frantic, they get nervous and then they can't think straight.

    00:41 So, what I tell people is take your own pulse when you see a baby who is seizing.

    00:46 Then, check the time.

    00:48 We need to know how long the seizure is been going on.

    00:52 And we need to take a second to describe the seizure look for eye movements Is this generalized or this focal and then became generalized.

    01:01 It is important to understanding all these things so we can make the diagnosis later.

    01:06 Focal seizures are often pathologic.

    01:09 and involve a problem in the brain whereas generalized seizures are more likely a seizure disorder or if the child is febrile, a simple febrile seizure.

    01:19 It is important to keep track of the ABC's. This is a common trick test question when they ask a complicated scenario and then the real answer is ABCs so remember your basic CPR.

    01:33 Place monitors on the child place an IV if you can but you can actually reverse a seizure without it I think In babies always get a D stick or a dextrose level because the glucose being low is a common cause for child having a seizure and may indicate either a metabolic disorder or a prolonged fasting state.

    01:53 If you are going to treat the seizure, we'll start with Midazolam.

    01:57 I prefer to give Midazolam through the nose and the reason I prefer that to say rectal Valium is it's a lot easier say in the supermarket to squirt something in a child's nose than to disrobe them and squirt something into their rectum.

    02:10 That aside, it is not commercially available typically to get nasal Midazolam compared to rectal Valium which they sell for quite a bit of money.

    02:21 In the hospital setting, we can also do IV or IM lorazepam Then we can continue to repeat the benzodiazepines at least two times until the seizure stops.

    02:36 After multiple administrations of benzodiazepines we may choose to move to an antiseizure med.

    02:43 In children under one, We would do phenobarbital and in children over one we usually start with something like levetiracetam.

    02:52 Now, let's go through these drugs.

    02:54 We've got Levetiracetam (commonly called Keppra), it's given at 40 mg/kg IV.

    03:01 You may not give it IM. And it's given over 10 minutes.

    03:04 It can be given a little bit faster and there's a benefit to that.

    03:08 The downside is fatigue.

    03:11 Phenobarbital is also 20 mg per kilo. You can see an easy dosing scheme here.

    03:18 It's better for children typically under one years of age but can cause sedation and low blood pressure or a low respiratory rate so be ready to provide some respiratory support.

    About the Lecture

    The lecture Status Epilepticus: Management by Brian Alverson, MD is from the course Pediatric Neurology.

    Included Quiz Questions

    1. Check the time/duration and describe the episode
    2. Provide mouth-to-mouth resuscitation
    3. Check for pulses
    4. Hold the tongue down with a spoon
    5. Call 911
    1. Nasal midazolam
    2. Intrarectal diazepam
    3. Intravenous phenytoin
    4. Intravenous magnesium sulfate
    5. Intravenous phenobarbital
    1. It can be given at a faster rate than phenytoin.
    2. It is less expensive compared to phenytoin.
    3. It is safer than phenytoin for children below 1 year of age.
    4. It is very effective even at small doses.
    5. It can sedate the patient.
    1. D-stick
    2. Urine drug screen
    3. Skin PPD test
    4. Blood culture
    5. Lumbar puncture

    Author of lecture Status Epilepticus: Management

     Brian Alverson, MD

    Brian Alverson, MD

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    Excellent lecture
    By Jalil Z. on 23. July 2020 for Status Epilepticus: Management

    Very good explanation of the steps and mindset to have in case of seizures. Clear explanation of the 3 anti-seizure medication.

    By Shirley C. on 02. April 2019 for Status Epilepticus: Management

    Me gusta porque es muy puntual con el tema, y el manejo del mismo

    I like this lecture very much , it is very helpfull for me
    By marwa h. on 27. January 2019 for Status Epilepticus: Management

    It is very usefull, focused and illustrative, clear voice I recoment it to all pediatrician and pediatric neurologist