NEUROLOGY + NEUROSURGERY
PAEDIATRIC SEIZURES
PromptCauses of seizures in kids (same as above but a little different)
ResponseInfantile spasms
Electrolyte disturbances
Hypoglycemia
alcohol/toxins
In born errors of metabolism
Epilepsy medication non compliance
Febrile seizures (3-6% of all kids)
Intracranial infection
Traumatic seizure
NAI >> TBI - low threshold for CTB
Breath holding spells
Night terrors
Neurocysticercosis if been to india (parasitic brain infection)
THE MISFITS - See Paeds
Electrolyte disturbances
Hypoglycemia
alcohol/toxins
In born errors of metabolism
Epilepsy medication non compliance
Febrile seizures (3-6% of all kids)
Intracranial infection
Traumatic seizure
NAI >> TBI - low threshold for CTB
Breath holding spells
Night terrors
Neurocysticercosis if been to india (parasitic brain infection)
THE MISFITS - See Paeds
PromptPaediatric status epilepticus airway management in escalating order
ResponseBVM +/- airway adjunct - Preferred as least invasive, likely to recover airway once post ictal + midaz wearing off + CO2 washing out
LMA second line if BVM fails
intubation/ventilation - if vomiting due to potential aspiration
LMA second line if BVM fails
intubation/ventilation - if vomiting due to potential aspiration
PromptSeizure termination meds in paediatrics
Response1st line:
- Midazolam 0.15 mg.kg IM/IV Q5min (Buccal 0.3mg/kg)
- Levetiracetam 40 mg over 5 minutes
- Phenytoin 20 mg/kg over 20 mins
- Phenobarbitone 20 mg/kg over 20 mins
- RCH
PromptRSI for paediatric seizure
ResponseKetamine - safe in ED, familiarity, maintains BP
Propofol 2.5 mg/kg (RCH)
Sux/roc
Adrenaline if hypotensive
Morphine/midazolam infusion for ongoing sedation
Consider vecuronium for ongoing paralysis once intubated.
Propofol 2.5 mg/kg (RCH)
Sux/roc
Adrenaline if hypotensive
Morphine/midazolam infusion for ongoing sedation
Consider vecuronium for ongoing paralysis once intubated.
PromptCauses of apnoea after seizure resolution.
ResponsePost ictal
Midazolam
Hypercapnoea (respiratory acidosis) from hypoventilation
Hypoglycaemia
Ongoing subclinical seizure
Coning due to SOL, ICH/SAH/SDH, cerebral oedema
Electrolyte abnormalities (including familial hypokalaemic paralysis)
Meningitis
Cord injury during seizure
Midazolam
Hypercapnoea (respiratory acidosis) from hypoventilation
Hypoglycaemia
Ongoing subclinical seizure
Coning due to SOL, ICH/SAH/SDH, cerebral oedema
Electrolyte abnormalities (including familial hypokalaemic paralysis)
Meningitis
Cord injury during seizure
PromptMRI vs CTB pros and cons in paediatric seizures
ResponseMRI
Pro: better picture, better diagnostics, no radiation
Cons: availability, slow (if time critical investigation) Claustrophobia (may need GA), can’t monitor child in tunnel, Expensive
CTB
Pro - Quick and available, GA rarely needed, good diagnostics for fractures/bleeds
Cons - worse than MRI for soft tissue/mass, Radiation (Cancer risk ~1:1000)
Pro: better picture, better diagnostics, no radiation
Cons: availability, slow (if time critical investigation) Claustrophobia (may need GA), can’t monitor child in tunnel, Expensive
CTB
Pro - Quick and available, GA rarely needed, good diagnostics for fractures/bleeds
Cons - worse than MRI for soft tissue/mass, Radiation (Cancer risk ~1:1000)