Pediatric Seizure Flashcards
How is the pediatric brain different from adult in regard to seizures?
Peds more prone to seizure, but also more likely to improve over time and possibly grow out of seizures
What are the critical first steps in managing an ongoing pediatric seizure?
Patent airway Give O2 to all seizing pts Assist ventilation if needed Check for and treat hypoglycemia Give benzos
What is the dosing for dextrose if needed to treat hypoglycemia in kids?
Infants: 4–5mL/Kg of 10% dextrose
Children: 2mL/Kg of 25% dextrose
IV/IO
What are the first-line treatments and doses for pediatric seizure?
Lorazepam 0.1 mg/kg or,
Midazolam 0.1–0.2mg/kg IV/IO
If no access, give 0.2mg/kg IN versed (max 10mg)
Repeat dosing in 5 minutes if no response and prepare to support blood pressure and breathing from repeat dosing
What are the second-line treatments and doses for pediatric seizure?
Given when 2 doses of benzos have been unsuccessful:
Infants: phenobarbitol 20mg/kg IV/IO (max 800mg)
Children: fosphenytoin 20PE/kg IV/IO over 20 minutes
What are third-line treatments for refractory status epilepticus in kids?
Valproic acid 20mg/kg IV/IO or
Levetiracetam 20–30mg/kg IV/IO
What are fourth-line treatments and doses for pediatric seizure?
Continuous infusions in the ICU:
Propofol or midazolam
In addition to the primary survey and the drugs to break the seizure, what else needs to be addressed and how?
Replete electrolytes
Hyponatremia: <120mEq/L, 3% NaCl 4–6mL/kg
Hypocalcemia: <7 mg/dL, 0.3mL/kg of 10% calcium gluconate over 10 minutes
Hypomag: <1.5 mEq/L, 50mg/kg mag sulfate over 20 minutes
Which kids with a seizure can be sent home?
Brief seizure that resolves on its own without full recovery and no focal neuro deficits
Which kids with seizure are admitted?
Status Epilepticus: even if terminated in the ED should still be admitted
All infants with true seizures
ICU for any refractory cases, or seizures from trauma, CNS infection, or serious metabolic or electrolyte abnormalities
What is the normal age for a febrile seizure?
6 months–6 years
What constitutes a complex febrile seizure?
lasting more than 15 minutes
Focal, not generalized seizure
Recurrent seizures
When do febrile seizures require testing and treatment?
Febrile status epilepticus is treated with standard seizure aborting agents and neuroimaging, CSF analysis and culture, and consideration of covering with antibiotics and acyclovir
Consider routine evaluation for the source of the fever
When is neuroimaging indicated in a first-time seizure?
Only if there are focal neuro deficits on exam
Which seizure patients require neuroimaging, lab work, and other evaluation?
Posttraumatic: consider head CT
Febrile status: Head CT and LP
Non-febrile status, focal seizure, or focal neuro deficit: neuroimaging, CMP, tox screens, ECG
Infants: Glucose, CMP, calcium, mg, ammonia, lactate, UA, CSF
