Status Epilepticus: Management

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.

02:21 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 levetiracetam.

02:52 Now, let's go through these drugs.

02:54 We've got Levetiracetam (commonly called Keppra), it's given at 40 mg/kg IV.

03:01 You may not give it IM. And it's given over 10 minutes.

03:04 It can be given a little bit faster and there's a benefit to that.

03:08 The downside is fatigue.

03:11 Phenobarbital is also 20 mg per kilo. You can see an easy dosing scheme here.

03:18 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.