Clinical Practice Guidelines 3 rd edition Prepared by [Insert name of presenter] [Insert title] [Insert Branch name] Day Month Year Infant & Children Acute Management of Seizures

Session Outline Changes from previous guideline Assessment & management Algorithm Medications in status epilepticus Escalation Post seizure care Summary

Changes from 2 nd edition Hypoglycaemia <3.0 mmols administer 2 mLs/kd 10% Dextrose Inclusion of IV Levetiracetam – second line therapy Control seizure without delay – the longer the seizure continues the hander to control Guideline is for Infants & Children – not neonates Rectal Diazepam removed Paraldehyde removed

Assessment Airway Breathing Circulation Disability Exposure Fluids Glucose

Algorithm

Algorithm continued

Mediations used in Acute Seizures First Line Rx Midazolam –Bucal/Intranasal –IV/IO/IM Diazepam IV Midazolam or Diazepam <1 hr prior to presentation should be regarded as “initial dose” Second Line RX Phenytoin IV/IO Levetiracetam IV/IO Phenobarbitone IV/IO Pyriodoxine IV/Oral/enteral Thiopentone Valporate

Escalation if …… Airway compromise requiring intubation Breathing compromise e.g. persistent hypoventilation, aspiration Circulatory compromise e.g. requiring more than 20 mL/kg fluid bolus Neurological compromise e.g. localizing signs – focal fit, asymmetry of movement, asymmetry of reflexes; prolonged depression of level of consciousness Prolonged seizures Seizures continuing after two doses of a benzodiazepine Suspected serious underlying cause of seizures e.g. meningitis, metabolic abnormality, head injury

Post Seizure Care Position child in recovery position, on left side Maintain airway (jaw thrust, chin lift, suction) Maintain continuous monitoring of pulse, respiratory rate, oximetry and neurological status until child is fully recovered Document observations on relevant SPOC/PEDOC 15 minutely until GCS normal

Summary It is important to attempt to control the seizure without delay as the longer the seizure continues the more difficult it becomes to control Timing is from onset of seizure, not from the arrival to the Emergency Department No more Diazepam or paraldehyde Levetiracetam included as a 2 nd line choice Assessment follows the A-G principles