If you see a patient who you suspect
is having a seizure what you do?
Well, the first thing we have to remember is
how much time it's been going on
It's key to ask the question is: When did it start?"
Remember, it takes at least 35 probably 45 minutes
baby or child is going to have brain damage from continuous seizing.
The first thing you should do if you encounter a patient seizing
is take your own pulse.
Calm down.
You have some time.
It's not
a rush or an emergency
and is the first thing I see students do on the wards
as they get frantic, they get nervous and then they can't think straight.
So, what I tell people is take your own pulse when you see a baby who is seizing.
Then, check the time.
We need to know
how long the seizure is been going on.
And we need to take a second to describe the seizure
look for eye movements
Is this generalized or this focal and then became generalized.
It is important to understanding all these things
so we can make the diagnosis later.
Focal seizures are often pathologic.
and involve a problem in the brain whereas generalized seizures
are more likely a seizure disorder
or if the child is febrile,
a simple febrile seizure.
It is important to keep track of the ABC's. This is a common
trick test question
when they ask a complicated scenario and then the real answer is
ABCs so remember your basic CPR.
Place monitors on the child place an IV if you can
but you can actually reverse a seizure without it I think
In babies always get a D stick
or a dextrose level
because the glucose being low is a common cause for child having a seizure
and may indicate either a metabolic disorder or a prolonged fasting state.
If you are going to treat the seizure, we'll start with Midazolam.
I prefer to give Midazolam through the nose
and the reason I prefer that to say rectal Valium
is it's a lot easier say in the supermarket
to squirt something in a child's nose
than to disrobe them and squirt something into their rectum.
That aside,
it is not commercially available typically
to get nasal Midazolam
compared to rectal Valium
which they sell for quite a bit of money.
In the hospital setting, we can also do IV or IM lorazepam
Then we can continue to repeat the benzodiazepines at least two times
until the seizure stops.
After multiple administrations of benzodiazepines
we may choose to move to an antiseizure med.
In children under one,
We would do phenobarbital
and in children over one we usually start with something like
Now, let's go through these drugs Fosphenytoin.
Fosphenytoin is a prodrug
is given a 20 mg per kilo
and it is either IV or IM and it's given over 10 minutes
Because its Fosphenytoin,
it can be given a little bit faster and there's a benefit to that
the downside is it's expensive.
Phenytoin is given at 20 mg per kilo IV
you may not give it IM
but you have to give it very slowly.
as a result,
it's a little bit more annoying
and takes a little longer for the seizure to stop.
also it can cause low blood pressure and dysrhythmias.
Phenobarbital is also 20 mg per kilo. You can see an easy dosing scheme here.
It's better for children typically under one years of age
but can cause sedation and low blood pressure
or a low respiratory rate so be ready to provide some respiratory support.