Status Epilepticus in Children

OVERVIEW

Status epilepticus is considered to have occurred when a generalised tonic-clonic seizure has lasted greater than 30 minutes.

APPROACH

Goals

  • Resuscitation
    Terminate seizures
    Clinical and Historical assessment for cause

Resuscitation

  • Call for help – anaesthesia, paediatric neurologist
  • Airway – open and secure airway, recovery position, high flow oxygen
  • Breathing – ensure ventilation
  • Circulation – ensure adequate circulation (20mL/kg crystalloid bolus), consider early antibiotic use to cover meningitis, routine bloods
  • Disability
    — check conscious state, interictal periods, localising signs, pupillary response, glucose level, check for full fontanelle and neck stiffness (meningitis)
    — terminate seizure:
    -> rectal diazepam – 0.5mg/kg
    -> buccal midazolam – 0.5mg/kg
    -> IV lorazepam 0.1mg/kg
    -> IV midazolam 0.15mg/kg
    -> PR paraldehyde 0.4mg/kg (mixed 1:1 in olive oil)
    -> phenytoin 18mg/kg over 30min
    -> phenobarbitone 20mg/kg IV over 20 min
    -> thiopentone 4mg/kg with RSI
    -> volatile anaesthesia
    -> surgery
  • Exposure – rash to suggest infectious cause (esp. meningococcaemia), fever, poisoning (ecstasy, cocaine, saliciylates)

Other Management

  • consider empiric therapy of intracranial hypertension (0.25-0.5g/kg mannitol)
  • look for complications: aspiration, arrhythmias, hypertension, APO, hyperthermia, DIC, rhabdomyolysis
  • maintain normoglycaemia
  • restrict fluids to 60% maintenance to avoid hyponatraemia
  • normalised sodium to 135-145
  • gastric decompression with NGT
  • normothermia
  • ventilate to CO2 – 35-40
  • dexamethasone 0.2mg/kg bd for cerebral oedema from SOL
  • IDC

Diagnostic possibilities (COMATOSE)

  • C – convulsion (primary or SOL)
  • O – overdose
  • M – meningitis
  • A – adrenal failure
  • T – trauma
  • O – organ failure
  • S – stroke
  • E – end stage hypoxic ischaemic encephalopathy

CCC Neurocritical Care Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.