In this video, Drs. Archana Patel, Agnieszka Kielian, and Leslie Hayes discuss the clinical management of Status Epilepticus in children outside of the neonatal period. They review the definition of Status Epilepticus, illustrate common clinical scenarios where it may be encountered, and review the medical management with a focus on medications available in resource-limited settings.
This video is intended for healthcare providers the clinical management of status epilepticus the learning objectives of this video include and illustrating common clinical scenarios management of status epilepticus with a focus on medications available in limited resource settings. prolonged seizures last between 5 and 30 minutes. as more than 30 minutes of either
Continuous seizures within 30 minutes without full recovery however, the operational definition of status epilepticus and this is the point at which we typically start administering medications. clinically, this means that if a patient arrives to your you should assume the patient is in status rescue medication as soon as possible. if you begin timing so you know the right
Time to to treat early for multiple reasons. first, increases if the seizure goes on for a long 5 minutes is less likely to resolve on medications used to stop the seizures, particularly status epilepticus can present with different seizure types. most commonly, you will see generalized and extension of the arms and legs, occurring occur in patients with known epilepsy,
Young in patients with infection, such as cerebral epilepticus is another type of status epilepticus this occurs when seizures are ongoing in a comatose motor movements. sometimes, there are subtle but most of the time there are no overt signs. of the body is affected, should be treated or at 10 minutes if consciousness is preserved. you assess the airway, breathing, and
Circulation place the child on his or her side, loosen mouth. place the patient on a monitor, if available, intravenous access. obtain a finger stick blood but if glucometer is not readily available, percent dextrose iv at the dose of 2-5 milliliters per kilogram. you should then we use to stop seizures can cause respiratory airway and breathing frequently and be prepared we
Will now walk you through the medications to administer them. our emphasis is on giving them appropriate medications within the recommended available on the algorithm pdf paired with this video. remember, this is a neurologic emergency. your team are working together and are prepared be administered quickly, if needed. the first benzodiazepine, preferably by an intravenous
Activity, you should first give diazepam iv if the patient does not have iv access at but please note the different dose of 0.5 milligrams per kilogram of a maximum of 20 milligrams. administer a second dose of diazepam at the depending on the available access. if another seizing after two doses of diazepam, it is depending on availability and access, your loading dose of
Phenetoin is 20 milligrams be careful infusion can rarely cause heart rate and blood pressure should be monitored another 15 minutes, you can give a second dose maximum 500 milligrams. if the seizure persists status and the next medication to administer the dose of 20 milligrams per kilogram, maximum what to do if you use phenobarbital after of 20 milligrams per kilogram
With a maximum intravenously, but can also be given intramuscularly if the seizure persists after 15 minutes, give per kilogram iv with a maximum dose of 1 cause bradycardia and hypotension, so the patient’s heart rate and blood pressure should be monitored closely. per kilogram, maximum 500 milligrams, after as additional medications are used to control monitor closely
The patient’s respiratory if available. if the convulsions continue after and phenobarbital, then the patient is in refractory a specialist to consider additional anti-epileptic steps to consider, would be medications like medications that are available in an enteral form only patients with refractory status epilepticus however, you should seek the guidance of a while the
First priority should be stopping discussed, you and your team members should this prolonged seizure and consider some of can help identify metabolic derangements in a full blood count may be suggestive of an infection. though, cell count may be elevated with seizure activity. is controlled, may be necessary to evaluate for infection is high enough, you should initiate you
May also want to obtain a head ct scan if stroke, or the patient remains unresponsive if eeg monitoring is available, it may be helpful status epilepticus. however, even without an examination to evaluate responsiveness to of non-convulsive status epilepticus, such unresponsive patient. after the resolution to continue monitoring the patient closely. to stop the seizure,
Maintenance doses of the duration of the child’s illness. this should rescue medication was given. more discussion symptomatic seizures or new epilepsy will be discussed elsewhere. prepared to take care of patients in status epilepticus.
Transcribed from video
"Management of Pediatric Status Epilepticus in Resource-Limited Settings" for OPENPediatrics By OPENPediatrics