| Timeline
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General Considerations
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Seizure Treatment
|
| 0-5 minutes
|
- Supportive care
- Check blood glucose
- Establish IV/IO access
- Acetaminophen 15 mg/kg rectally if fever
|
- Benzodiazepine: first dose
- IV/IO access establised
- Lorazepam 0.1 mg/kg IV or IO (max = 4 mg), OR
- Diazepam 0.2 mg/kg IV or IO, (max = 8 mg)
- IV or IO access not achieved within 3 minutes:
- Buccal midazolam 0.2 mg/kg (max = 10 mg), OR
- IM midazolam 0.1 to 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
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- Give antibiotics if signs of sepsis or meningitis
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- Benzodiazepine: second dose
|
| 10-15 minutes
|
|
- Antiepileptic: first therapy
- Levetiracetam 40 mg/kg IV or IO, OR
- Fosphenytoin¶ 20 mg PE per kg IV or IO§, OR
- Valproate 20 to 40 mg/kg IV or IO, OR
- Phenobarbital 20 mg/kg IV or IO, maximum 1 g, (expect respiratory depression with apnea)¥
|
| 15-30 minutes
|
- Obtain pediatric neurology consultation
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- Antiepileptic: second therapy
- Fosphenytoin¶ (if not already given) 20 mg PE per kg IV or IO◊, OR **Valproate (if not already given) 20 to 40 mg/kg IV or IO, OR
- Phenobarbital (if not already given) 20 mg/kg IV or IO, maximum 1 g (10 mg/kg if phenobarbital lready given)¥, OR
- Levetiracetam (if not already given) 40 mg/kg IV or IO, *Consider pyridoxine if INH poisoning suspected
- Infants (<1 year): 100 mg IV or IO in **Otherwise 70 mg/kg IV or IO (max = 5 g)
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