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Flashcards in STATUS EPILEPTICUS Deck (10):
1

What is the definition of status epilepticus in children?

A seizure lasting 30 minutes or longer, or when successive seizures occur so frequently that the patient does not recover consciousness in between.

2

Alice is a 10 year old who was waiting to be seen in the neurology clinic when starting having a tonic/clonic seizure. She has been convulsing now for 5 mins. Alice does not have a cannula in place. What is the management of Alice?

DR ABCDE

Check glucose - if less than 3 mmol/L give glucose IV and recheck

In terms of anticonvulsants there are two first line options if there is no IV access:

Rectal diazepam 0.5 mg/kg

OR

Buccal midazolam 0.5 mg/kg

3

Alice is a 10 year girl who is seizing. She has no cannula in place so after 5 mins of convulsing you give her 0.5 mg/kg of rectal diazepam. How long would you wait before administering more anticonvulsant?

5 mins - you should try and gain IV access at this point unless it is unsafe to do so.

4

Alice is a 10 year girl who is seizing. She has no cannula in place so after 5 mins of convulsing you give her 0.5 mg/kg of rectal diazepam. 5 mins later she is still seizing. What do you do now?

If IV access has now be achieved she should be given lorazepam 0.1 mg/kg IV

If IV access has not yet been achieved she should needs senior help and:

Phenytoin 18 mg/kg IO over 20 min

OR

Phenobarbital 15 mg/kg IO if on oral phenytoin

5

Alice is a 10 year old girl who is seizing. She has no cannula in place. After 5 minutes she was given rectal diazepam. 10 minutes later she was still convulsing and you had still not managed to gain IV access. As a result you called your senior and you both agreed to start her on phenytoin IO to be given over 20 mins. She is not showing any signs of recovery 10 minutes later. What should you do?

Call an anaesthetist

She will have rapid-sequence induction with thiopental, mechanical ventilation and transfer to PICU.

6

You are a FY2 in paediatrics and you are called to see Rob, a 10 year old on the neurology ward who started convulsing with what appears to be a tonic/clonic seizure. As an inpatient he has a cannula in place. He has now been convulsing for 5 mins. How are you going to manage Rob?

DR ABCDE

Check glucose - if less than 3 mmol/L give glucose IV and recheck

With IV access first line anticonvulsant is:

Lorazepam 0.1 mg/kg IV

7

You are a FY2 in paediatrics and you are called to see Rob, a 10 year old on the neurology ward who started convulsing with what appears to be a tonic/clonic seizure. As an inpatient he has a cannula in place. When you got to him he had been seizing for 5 mins so you gave him lorazepam IV. How long should you wait before giving more medication?

10 mins

8

You are a FY2 in paediatrics and you are called to see Rob, a 10 year old on the neurology ward who started convulsing with what appears to be a tonic/clonic seizure. As an inpatient he has a cannula in place. When you got to him he had been seizing for 5 mins so you gave him lorazepam IV. 10 minutes later there has been no change. What should do at this point?

Give another dose of lorazapam 0.1 mg/kg IV

9

You are a FY2 in paediatrics and you are called to see Rob, a 10 year old on the neurology ward who started convulsing with what appears to be a tonic/clonic seizure. As an inpatient he has a cannula in place. When you got to him he had been seizing for 5 mins so you gave him lorazepam IV. 10 minutes later there has been no change so you give another dose of the lorazepam IV. How long should you wait before intervening again?

10 minutes

10

You are a FY2 in paediatrics and you are called to see Rob, a 10 year old on the neurology ward who started convulsing with what appears to be a tonic/clonic seizure. As an inpatient he has a cannula in place. When you got to him he had been seizing for 5 mins so you gave him lorazepam IV. 10 minutes later there has been no change so you give another dose of lorazepam. A further 10 minutes passes and he is still convulsing. What should you do now?

Call for senior help

Phenytoin 18 mg/kg IV over 20 min

OR

Phenobarbital 15 mg/kg IV if on oral phenytoin

If this fails she will need an anaesthetist, thiopental and mechanical ventilation in PICU.