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.