Template:Initial management of pediatric status epilepticus

Initial management of pediatric status epilepticus

Timeline	General Considerations	Seizure Treatment
0-5 minutes	Supportive care ABC's Maintain airway; suction, jaw thrust Provide O2 via non-rebreather mask, 10-15 L/min or BVM if apneic/hypoventilating Establish IV/IO access Check blood glucose If fever, acetaminophen 15 mg/kg rectally	Benzodiazepine: first dose IV/IO access established Lorazepam 0.1 mg/kg IV (max 4 mg) if IV/IO access, OR Diazepam 0.2 mg/kg IM (max 10 mg) if no access IV or IO access not achieved within 3 minutes: Buccal midazolam 0.2 mg/kg (max 10 mg), OR IM midazolam 0.2 mg/kg (max 10 mg), OR Rectal diazepam (Diastat gel or injection solution given rectally) 0.5 mg/kg (max 20 mg)
5-10 minutes	Give antibiotics if concern for sepsis or meningitis POC electrolytes, if available	Benzodiazepine: second dose
10-15 minutes		Antiepileptic: first therapy Levetiracetam 60 mg/kg IV/IO (max 4500mg) over 5 min, OR Fosphenytoin^ 20 mg PE/ kg IV/IO (max 1500mg) over 10 min, OR Valproate 40 mg/kg IV/IO (max 3000mg) over 10 min, OR Phenobarbital 20 mg/kg IV/IO, (max 1 g) over 20 min, (expect respiratory depression with apnea)¥
15-30 minutes	Consider intubation, if not already performed Pediatric neurology consultation	Antiepileptic: second therapy if not already given Fosphenytoin^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR Valproate 40 mg/kg IV/IO (max 3000mg) over 10 min, OR Phenobarbital 20 mg/kg IV/IO (max 1 g) over 20 min (10 mg/kg if phenobarbital already given), OR Levetiracetam 60 mg/kg IV/IO (max 4500mg) over 5 min, If isoniazid toxicity suspected, pyridoxine Infants (<1 year): 100 mg IV or IO in Otherwise 70 mg/kg IV or IO (max = 5 g)

^May be ineffective for toxin-induced seizures and contraindicated in cocaine toxicity