Paediatric Acute care Guidelines PMH Emergency Department

Convulsive status epilepticus is defined as a generalised tonicclonic convulsion lasting more than 30 minutes, or repeated tonicclonic convulsions over a 30 minute period without recovery of consciousness between each convulsion.

Background

  • Status epilepticus is the most common neurological medical emergency
  • It is the first seizure in 30% of status epilepticus patients
  • Mortality is 1-3%

Status-epilepticus-2013.12.11

General

  • The estimated incidence is 20 per 100 000 children per year.

Causes of Status Epilepticus:

  • Prolonged febrile convulsion
  • Epilepsy
  • Central nervous system infection (e.g. meningitis)
  • Trauma
  • Metabolic
  • Poisons

Assessment

History

  • Description of the manifestation of the seizures obtained from the eyewitnesses (parent, carer, etc)
  • Any impairment or loss of consciousness
  • Motor effects, muscular contractions
  • Parts of the body that are affected
  • Focal or tonic/clonic seizure
  • Length of seizure
  • Multiple clusters of seizure activity

Examination

  • Full systems examination including neurological examination
  • Examine for underlying causes that can precipitate seizures

Investigations

  • Always do a blood glucose level (BGL)
  • Venous blood gas
  • Consider other investigations according to the possible underlying aetiology e.g. infectious screen, anti-epileptic drug levels

Management

  • Assess ABC first
  • The approach to a child who presents with a tonic-clonic convulsion > 5 minutes should be the same as for the child with established status epilepticus
  • This guideline addresses the treatment of status epilepticus and not the underlying cause – once the seizure has been terminated, investigate as required

Initial management

  • ABC
  • Airway adjuncts – consider an oropharyngeal or nasopharyngeal airway as required
  • High flow oxygen
  • Vascular access (and check BGL)

Medications

See Seizure – Medication

Nursing

  • Follow the Status Epilepticus Flowchart and prepare drugs as required
  • Any child having a prolonged seizure should be nursed in resuscitation room if possible
  • Prepare to insert 2 x intravenous cannulae or intraosseous needles
  • Check BGL and inform doctor

Observations

Baseline Observations:

  • Temperature
  • Heart Rate
  • Respiratory Rate
  • Blood Pressure
  • GCS
  • Pupil reaction

During A Phenytoin Infusion:

  • 5 minutely BP, HR, respiratory rate, during infusion and flush for 30 minutes post-flush
  • Advise doctor immediately if any change in patients condition
  • Infusion may need to be slowed or stopped in case of hypotension, impaired respiratory effort or bradycardia

Post Ictal Stage:

  • Observe closely for further seizure activity
  • 1/2 hourly neurological observations until GCS 15

We want your feedback!

Help us provide guidelines that are useful to you, the clinician.

Give feedback here