The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.
Timeline
|
General Considerations
|
Seizure Treatment
|
0-5 minutes
|
- Supportive care
- ABC's
- Maintain airway; suction, jaw thrust
- Provide O2 via positive pressure ventilation with BVM/Mapleson
- Likely apneic/hypoventilating/hypercapneic
- Only apply CPAP or a non-rebreather if patient stops seizing and has adequate 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
|
10-15 minutes
|
- All equally efficacious for status epilepticus
- Levetiracetam is preferred given quick administration, favorable side effect profile, and less drug interactions
- Do not combine Phenytoin and Fosphenytoin
|
- 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
- Consider NG tube to decompress stomach prior to intubation
- 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)
|
>30 minutes
|
- Intubate patient, if not already performed
- Consult referral site / PICU for admission and continuous EEG
|
- Antiepileptic: third therapy
- Midazolam 0.2mg/kg IV bolus (max 10mg), followed by 0.2mg/kg/hr (max 10mg/hr) infusion drip
- Increase infusion rate by 0.2mg/kg/hr (max 10mg/hr) every 10 minutes until burst suppression or max dose of 2mg/kg/hr (max 100mg/hr)
|
^May be ineffective for toxin-induced seizures and contraindicated in cocaine toxicity