Seizure - Pediatric

 

History:

 

  • Reported/witnessed seizure activity
  • Previous seizure history
  • Seizure medications
  • History of recent head trauma
  • Fever
  • Congenital abnormality
  • Consider pregnancy in teenage females

 

Significant Findings:

 

  • Decreased mental status
  • Sleepiness
  • Observed seizure activity
  • Hot, dry skin/hyperthermia

 

Differential:

 

  • CNS (head) trauma
  • Tumor
  • Hypoxia/respiratory failure
  • Drugs/medications
  • Fever
  • Infection
  • Metabolic abnormality/acidosis

 

Actively seizing for at least 15 minutes ?

  • seizure should cease without medications

 

  • Yes

 

 

 

    • Oxygen

 

 

 

    • Consider 12-Lead EKG
    • Obtain BGL

 

 

 

 

 

 

    • Initiate IV

 

Still seizing ?

 

  • Yes

 

 

 

 

No seizure on initial contact ?

 

 

 

    • Oxygen

 

 

 

    • Consider 12-Lead EKG
    • Obtain BGL

 

 

 

    • Initiate IV

 

Seizure ?

 

  • Yes

 

 

 

 

 

Still seizing ?

 

  • Yes

 

 

 

 

Glucose <60 with signs of hypoglycemia ?

 

  • Yes

 

 

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

  • Pediatric = 1 day to less than age 12, or less than 55 kg in ages 13-18.
  • Use Broselow tape for drug dosages.
  • Addressing the ABC's and verifying blood glucose is more important than stopping the seizure.
  • Avoiding hypoxemia is extremely important.
  • Remember to look for evidence of trauma and treat accordingly.
  • Status epilepticus is defined as two or more successive seizures without a period of consciousness or recovery. This is a true emergency requiring rapid airway control, treatment, and transport.
  • Grand mal seizures (generalized) are associated with loss of consciousness, incontinence, and tongue trauma.
  • Focal seizures (petit mal) effect only a part of the body and do not usually result in a loss of consciousness.
  • Jacksonian seizures are seizures, which start as a focal seizure and become generalized.
  • Be prepared to assist ventilations especially if Midazolam (Versed) is used.
  • If evidence or suspicion of trauma, spine should be immobilized.
  • In an infant, a seizure may be the only evidence of a closed head injury.

 

 

  • If family has Diastat on scene, Paramedics may give per medication instructions.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NREMT-I

National Registry EMT-Intermediate

OLMC

Online Medical Control - Contact Medical Control

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

OLMC

Online Medical Control - Contact Medical Control

NRAEMT

National Registry Advance Emergency Technician

NRP

National Registry Paramedic