Status Epilepticus is defined as ongoing seizure activity for greater than 20 minutes or repetitive seizures without return of consciousness for greater than30 minutes.
Any child presenting with status epilepticus is at a risk of irreversible brain injury and needs immediate management:
Initial Stabilization
1. The first priority of treatment is to ensure an adequate airway and to assess the cardiovascular status i.e look for ABC = airway, breathing and circulation.
2. Maintain an IV access.
3. Oxygen is administered and pulse oximetery observed.
4. ECG monitoring is done.
5. If violent muscle activity impairs ventilation, muscle paralysis and sedation should be instituted.
6. Immediate laboratory tests that need to be done include:
- Blood glucose
- Basic metabolic panel (sodium, calcium, magnesium)
- Antiepileptic drug levels
- Toxicology screening
1. Initial management is usually with a benzodiazepine, lorazepam 0.05 to 0.1 mg/kg, diazepam 0.1 to 0.3 mg/kg and midazolam 0.2 mg/kg all are effective agents.
2. Alternatively or even simultaneously, administration of either phenytoin 10-15 mg/kg or fosphenytoin 10-20 mg/kg at a rate of 1 mg/kg/min is effective.
3. If the seizures do not stop with these measures, a continuous IV infusion of diazepam, loading dose of 10-20 mg/kg of phenobarbital, or IV valproic acid at a dose of 20 mg/kg is appropriate.
4. If this approach is also not effective in aborting the seizures then preparation for general anesthesia are undertaken.
No comments:
Post a Comment