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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.

    02:22 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 Now, let's go through these drugs Fosphenytoin.

    02:54 Fosphenytoin is a prodrug is given a 20 mg per kilo and it is either IV or IM and it's given over 10 minutes Because its Fosphenytoin, it can be given a little bit faster and there's a benefit to that the downside is it's expensive.

    03:12 Phenytoin is given at 20 mg per kilo IV you may not give it IM but you have to give it very slowly.

    03:21 as a result, it's a little bit more annoying and takes a little longer for the seizure to stop.

    03:26 also it can cause low blood pressure and dysrhythmias.

    03:31 Phenobarbital is also 20 mg per kilo. You can see an easy dosing scheme here.

    03:38 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.
    2. Provide mouth-to-mouth resuscitation.
    3. Check for pulses.
    4. Hold the tongue down with a spoon.
    5. Call 911.
    1. Intranasal midazolam
    2. Intrarectal diazepam
    3. Intravenous phenytoin
    4. Intravenous magnesium sulphate
    5. Intramuscular dantrolene
    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 one 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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