Chapter 9 The convulsing child Flashcards
How many minute till a seizure is status epilepticus?
30 minutes OR
successive seizures occurring so frequently that they do not fully recover across a 30 minute period
What are the common causes for convulsions?
Fever (age < 6)
Meningoencephalitis
Epilepsy
Hypoxia
Metabolic abnormalities
Can febrile seizures progress to convulsive status epilepticus?
Yes, 5 % present in convulsive status epilepticus
What is the cause of death in status epilepticus?
1) Complications of seizure (airway obstruction, hypoxia, aspiration, arrhytmias, pulmonary oedema, hyperthermia, DIC, myoglobinuria, neurological injury)
2) Complications of medications
3) Progression of underlying disease process
What does decorticate or decerebrate posturing during a seizure suggest?
Raised ICP
Don’t mistake their postures for the tonic phase of a convulsion
Is that standard pathway for treatment of status epilepticus applicable to all seizures in all children?
No
It’s for convulsive seizures
It’s not for neonates
What is the dose of intranasal/buccal midazolam
0.3mg/kg
What is the dose of IV midazolam?
0.15mg/kg
What is the dose of levitiracetam?
(what is it for APLS and in CRED book)
APLS = 40mg/kg max 3g
CRED = 60mg/kg max 4.2g
What is the dose of phenytoin?
20mg/kg over 20 minutes
What are the reversible causes of a seizure?
Hypoglycaemia
Hyponatraemia
Hypertensive emergencies
Meningitis
Intracranial haemorrhage
Raised ICP
How quickly is levetiracetam infused?
5 minutes
Why would you give paracetamol during status epilepticus?
To bring down the fever. Can give PR of IV
What is the maximum osmolality that is acceptable when treating raised ICP with hypertonic saline
Max serum osmolality is 360mOsml/L
What are the causes for a hypertensive crisis in children?
Dysplastic kidneys
Reflux nephropathy
Glomerulonephritis
Coartication of the aorta
How to children with a hypertensive crisis present
Neurological symptoms common - headache, seizures, hemiparesis, facial palsy
Babies may present with apnoea or cardiac failure
You suspect a patient is having a seizure due to raised ICP, how do you treat this?
Intubate
Head up 20 degrees
Hypertonic saline 3% 3ml/kg over 15 -30 min
What harm can be done by dropping the BP too quickly in hypertensive urgency?
Optic nerve infarction
Neurological damage
