Suspected Seizure Flashcards
What is the initial management of status epilepticus?
After 5 min of fitting
If vascular access:
IV/IO lorazepam (0.1 mg/kg)
If no: Buccal Midazolam (0.5mg/kg) Rectal Diazepam (0.5mg/kg)
What is the second stage of management of status epilepticus if patient is still fitting?
After 10 mins of fitting
IV/IO Lorazepam (0.1 mg/kg)
CALL FOR SENIOR HELP
If not on phenytoin: Prepare phenytoin
If already on phenytoin: Prepare phenobarbitone
Optional: Paraldehyde (0.8ml/kg 50:50 infusion with oil) Give while preparing phenytoin (DO NOT DELAY PHENYTOIN)
What is the third stage of management of status epilepticus?
Reconfirm it is an epilectic seizure
Seek anaesthetic/ICU advice
Not on phenytoin: Give phenytoin (20mg/kg) given IV/IO over 20 minutes
On phenytoin: Give phenobarbitone (20mg/kg) given IV/IO over 20 minutes
What is the fourth step in the management of status epilepticus?
Anaesthetist must be present
Rapid Sequence Induction (RSI) with thiopental
Child’s GCS
Eye Opening
E4 Spontaneous E3 To voice E2 To pain E1 None C Eyes closed (by swelling or bandage)
Child’s GCS
Motor
M6 Obeys commands Normal spontaneous movements
M5 Localises to supraorbital pain (>9 months of age) or withdraws to touch
M4 Withdraws from nailbed pain
M3 Flexion to supraorbital pain (decorticate)
M2 Extension to supraorbital pain (decerebrate)
M1 No response to supraorbital pain (flaccid)
Child’s GCS
Verbal
V5 Orientated Alert, babbles, coos, words or
(in person or place or address) sentences to usual ability (normal)
V4 Confused Less than usual ability, irritable cry
V3 Inappropriate words Cries to pain
V2 Incomprehensible sounds Moans to pain
V1 No response to pain
T Intubated
Differential Diagnosis for a child with seizure
Febrile seizure Encephalopathy Encephalitis/meningitis Post-ictal Sepsis/shock Brain tumour Epilepsy Metabolic disorder - The younger the unconscious child, the higher the possibility of a metabolic cause for being persistently unconscious/encephalopathic or intractable seizures. Family history of infant deaths. Poisoning/intoxication - Similarly, should be actively ruled out in any patient, if persistent encephalopathic
Other conditions to consider in an unconscious child include: Trauma/ head injury, hypertension, hydrocephalus
Questions to ask parents about a seizure
Prior to the episode
During Episode
Post-Episode
Recent Illness
Prior to episode (10)
Behavioural change Health that day Circumstances Time of episode Setting Activity at onset Warning: visual, hearing, fear, sweaty, light headedness Objective warning Triggers Time of last meal
During episode (14)
Onset- sudden? Unresponsive Awareness Symmetrical? Facial movement Eye movements Posturing Motor movements Clonic/ myoclonic/spasm or tonic Breathing changes Incontinence Autonomic Visual disturbance Duration of seizure
Post-Episode (7)
Sleepy/disorientated Nausea, vomiting Amnesia for events Strange behaviour Weakness Injuries: tongue Time to recovery
Recent Illness (11)
fever chestiness diarrhoea weight loss Recent headaches Head injury/trauma visual disturbances vomiting or nausea personality change poor co-ordination new weakness Taken drug/substance
What is epilepsy?
Tendancy to intermittent abnormal electrical brain activity
1% of children will have a seizure (not associated with fever) by the age of 14
At least two unprovoked seizures occurring >24 h apart
One unprovoked seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
Diagnosis of an epilepsy syndrome
What is the difference between partial epilepsy and generalised epilepsy?
Partial epilepsy: Can be localised to one part of a hemisphere
Generalised: Cannot be localised
