Status Epilepticus

Clinic A/P, adults, Clinic A/P, Peds, Hospital A/P, Adults, Hospital A/P, Peds

–New definition of Status Epilepticus, reviewed.

To be completed…

  • Attend to the ABCs before starting any pharmacologic intervention
  • Place patients in the lateral decubitus position to avoid aspiration of emesis and to prevent epiglottis closure over the glottis
  • Make further adjustments of the head and neck if necessary to improve airway patency
  • Immobilize the cervical spine if trauma is suspected
  • Administer 100% oxygen by facemask
  • Assist ventilation and use artificial airways (eg, endotracheal intubation) as needed
  • Suction secretions and decompress the stomach with a nasogastric tube.
  • Carefully monitor vital signs, including blood pressure
  • Carefully monitor the patient’s temperature, as hyperthermia may worsen brain damage
  • In the first 5 minutes of seizure activity, before starting any medications, try to establish IV access and to obtain samples for laboratory tests and for seizure medication
  • Infuse isotonic IV fluids plus glucose at a rate of 20 mL/kg/h (eg, 200 mL D5NS over 1 h for a 10-kg child)
  • In children younger than 6 years, use intraosseous (IO) infusion if IV access cannot be established within 5-10 minutes
  • If serum glucose is low or cannot be measured, give children 2 mL/kg of 25% glucose
  • If the seizure fails to stop within 4-5 minutes, prompt administration of anticonvulsants may be indicated

 

References

Epilepsy Curr. 2016 Jan-Feb; 16(1): 48–61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749120/

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