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SEIZURES
Dr Jonny Taitz, FRACP
Geschn Paediatrician
Sept 2003
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Introduction
Common
8% of children will have a seizure by
15 years of age
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Seizure
Sudden
Attack of altered behaviour
LOC
abnormal sensation, automaticfunction
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Most Common
Tonic (stiffening)
Clonic (jerking)
AbsenceMyoclonic
Atonic
Focal
MOST ARE BRIEF
TERMINATE SPONTANEOUSLY
50% in childhood = febrile convulsion
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Which seizures do we
treat?> 5 minutes brain hypoxiaStatus epilepticus
Generalised seizures > 30 minsOR
Repeated convulsions > 30 mins with NO
recovery & consciousness betweenconvulsions
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ComplicationsAge related > 3 yr - 6%
< 1 yr - 30%
- Long term epilepsy
- Motor problems
- Learning &behavioural problems
5% mortality (1/20)
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Guidelines aim JHH SHC
CHW
clear, succint guidelines inthe care of acute seizures
Many different anticonvulsants
Different routes of administration Intravenous Intramuscular Rectal
Oral
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ImportantSeizures < 15 minutes muchmore likely to respond to Rx
than seizures > 15 minutes
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History? Febrile illnessUnderlying CNS problems
History of epilepsyHead trauma
toxin ingestion
1assessment
ABC
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Specific features on examAirway intubationBreathing hypoventilation, aspiration,
O2, mask ventilation
Circulation shock, fluid bolusesNeurological focal signs, LOC, RIP, asymmetrical seizures
Underlying illness trauma, meningitis,head injury, metabolic
abnormalities
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Management
Priority no 1: ABC
Airway(Control seizures control airway)
Breathing Effective and efficient
All fitting kids high flow O2
NB: repeated seizures
high dose anticonvulsants
Circulation}
Resp
depression? Intubate +ventilate Circulation
Rx shock
Fluid Boluses
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Management (contd)
NEVER FORGET!!! GLUCOSE + BP
Hypoglycaemia Rx 5mls/kg 10% Dextrose
Hypertension Antihypertensives:
(I.e nifedipine, hydralazine)
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Questions to ask
Do I have vascular access?
What anticonvulsants areavailable?
How many minutes has the
child been fitting?
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Vascular AccessYes NoDiazepam 0.25mg/kg IVI Diazepam 0.25mg/kg PR
Or Midazolam 0.15mg/kg IVI Or Midazolam 0.15mg/kg IMI
5 Access
Repeat Diazepam IVIOr Midazolam IVI
No
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LOAD repeat
Phenytoin 20 mg/kg IVI Diazepam or Midazolamor Phenobarb 20mg/kg IVI
20
Rapid sequence induction Paraldehyde 0.4mg/kg PR
Thiopentone, Atropine, Dilute 50:50 (olive oil)
Suxemethonium
Supportivemeasures
ABC
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A little more on
anticonvulsantsDiazepam Effective first line in 80%
Rectal admin therapeutic levels 5minutes
Rapid seizure control (80%)
S/E 9% risk of respiratory depressionHigher in children with CNS abnormalities
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A little more on
anticonvulsantsMidazolam NSW Ambulance drug of first choice in
status epilepticus (IMI)
Will stop majority of seizures within 1minute (IVI)
Takes longer when used IM (approx 5-10 mins)
Intransal midazolamMore info required before recommending it
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Midazolam (contd)
Paraldehyde Used since 1930s
Very dangerous IVI Well tolerated rectally Rapid onset of seizure control Less respiratory depression than
Benzodiazepines Smells
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Questions