scottish paediatric retrieval service (edinburgh) … · 2019. 4. 12. · • status epilepticus is...
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Scottish Paediatric Retrieval Service (Edinburgh)
www.paedsretrieval.com
Standard Operating Procedure – Status Epilepticus
Date written: October 2010
Review date:
Related documents:
Author: Emma-Beth Wilson
Approved by:
Aims
• To outline the treatment of Status Epilepticus
• To recognize complications of patients with prolonged seizure activity
Background
• Status Epilepticus is life threatening but mortality is lower in children (4%) than in
adults (10-20%).
• Death may be due to complications of the convulsion, such as obstruction of the
airway, hypoxia, and aspiration of vomit, overmedication, and cardiac arrhythmias or
to the underlying disease process.
• Status Epilepticus is defined as a seizure lasting 30 minutes or longer or when
successive convulsions occur so frequently over a 30-minute period that the patient
does not recover consciousness between them.
• It can be further divided into convulsive or non-convulsive.
• Fever and known epilepsy are the most common causes.
• Also consider CNS infection, hyponatraemia, head injury, space occupying lesion,
blocked VP shunt, overdose, hypoxia, ischaemia, and metabolic problem.
Application
• Referring hospital team, Retrieval doctors, ANPs, nursing staff and SAS paramedics.
Policy
1. Patients appropriate for retrieval team involvement
• Patients with prolonged seizure activity unresponsive to medical therapy
• Patients with potential airway problems due to seizure activity or medications used to
stop seizure
2. Acute medical management – See flowchart
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• Administer high flow oxygen
• Assess and monitor cardio-respiratory function
• Check blood glucose (give 2ml/kg 10% dextrose if hypoglycaemic). Aim for 4-6mmols/L
• Secure IV access. If IV access difficult or taking time give rectal diazepam 0.5mg/kg
(max 10mg) or buccal midazolam 0.5mg/kg (max 10mg).
• Once IV/IO access secured give IV/IO lorazepam 0.1 mg/kg (max 4mg).
• Repeat after 10 minutes if no response
• Ensure adequate airway and ventilatory drive maintained throughout. Contact
anaesthesia if any concerns.
3. Refractory status epilepticus
• This management should take place in a Resuscitation room/ICU/Anaesthetic room
• Paraldehyde 0.4ml/kg PR (8ml/kg of prepared solution)
• If patient not on phenytoin normally: Phenytoin 18mg/kg IV/IO over 30 min (make up
with 50ml normal saline and infuse at 50mg/min with ECG monitoring
• If patient is on phenytoin: Phenobarbitone 20mg/kg IV, give over 20 minutes – watch
for hypotension
• If seizure activity still present contact anaesthetic team for consideration of
anaesthesia to terminate seizures
4. Additional measures
• Check for hyponatraemia. If Na < 135 and still seizing or Na < 130 give consider bolus
of 3ml/kg 3% saline (discuss with PICU)
• Keep temp < 37°C
• If suspicion bacterial meningitis give ceftriaxone 80mg/kg IV, if encephalitis suspected
add aciclovir
• Check ammonia in neonate
Reassess and Consider:
• Ongoing seizures? (HR, BP, pupils). Aim to terminate seizures with midazolam
infusion. Bolus 0.1mg/kg then 20mcg/kg/min.
• Discuss any further management with PICU Consultant/Neurology
• CT if suggestion raised intracranial pressure or focal lesion
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