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| Line 10: |
Line 10: |
| ** ABC's | | ** ABC's |
| ** Maintain airway; suction, jaw thrust | | ** Maintain airway; suction, jaw thrust |
| ** Provide [[O2]] via non-rebreather mask 10-15 L/min | | ** Provide [[O2]] via CPAP/PPV with BVM/Mapleson if apneic/hypoventilating |
| ***BVM if apneic/hypoventilating
| | ***Only use a non-rebreather mask 10-15 L/min if patient is ventilating on their own with visible chest rise |
| *Establish IV/[[IO]] access | | *Establish IV/[[IO]] access |
| *Check blood glucose | | *Check blood glucose |
| Line 34: |
Line 34: |
| | 10-15 minutes | | | 10-15 minutes |
| || | | || |
| | *All equally efficacious for status epilepticus |
| | *Levetiracetam is preferred given quick administration, favorable side effect profile, and less drug interactions |
| || | | || |
| *'''Antiepileptic: first therapy''' | | *'''Antiepileptic: first therapy''' |
Revision as of 15:38, 13 December 2022
| Timeline
|
General Considerations
|
Seizure Treatment
|
| 0-5 minutes
|
- Supportive care
- ABC's
- Maintain airway; suction, jaw thrust
- Provide O2 via CPAP/PPV with BVM/Mapleson if apneic/hypoventilating
- Only use a non-rebreather mask 10-15 L/min if patient is ventilating on their own with visible chest rise
- Establish IV/IO access
- Check blood glucose
- If fever, acetaminophen 15 mg/kg rectally
|
- Benzodiazepine: first dose
- IV/IO access established
- Lorazepam 0.1 mg/kg IV (max 4 mg) if IV/IO access, OR
- Diazepam 0.2 mg/kg IM (max 10 mg) if no access
- IV or IO access not achieved within 3 minutes:
- Buccal midazolam 0.2 mg/kg (max 10 mg), OR
- IM midazolam 0.2 mg/kg (max 10 mg), OR
- Rectal diazepam (Diastat gel or injection solution given rectally) 0.5 mg/kg (max 20 mg)
|
| 5-10 minutes
|
- Give antibiotics if concern for sepsis or meningitis
- POC electrolytes, if available
|
- Benzodiazepine: second dose
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| 10-15 minutes
|
- All equally efficacious for status epilepticus
- Levetiracetam is preferred given quick administration, favorable side effect profile, and less drug interactions
|
- Antiepileptic: first therapy
- Levetiracetam 60 mg/kg IV/IO (max 4500mg) over 5 min, OR
- Fosphenytoin^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR
- Valproate 40 mg/kg IV/IO (max 3000mg) over 10 min, OR
- Phenobarbital 20 mg/kg IV/IO, (max 1 g) over 20 min, (expect respiratory depression with apnea)¥
|
| 15-30 minutes
|
- Consider intubation, if not already performed
- Pediatric neurology consultation
|
- Antiepileptic: second therapy (if medication not already given)
- Fosphenytoin^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR
- Valproate 40 mg/kg IV/IO (max 3000mg) over 10 min, OR
- Phenobarbital 20 mg/kg IV/IO (max 1 g) over 20 min
- 10 mg/kg if phenobarbital already given, OR
- Levetiracetam 60 mg/kg IV/IO (max 4500mg) over 5 min
- If isoniazid toxicity suspected, pyridoxine
- Infants (<1 year): 100 mg IV or IO in
- Otherwise 70 mg/kg IV or IO (max = 5 g)
|
^May be ineffective for toxin-induced seizures and contraindicated in cocaine toxicity
