Status Epilepticus
Convulsive Status Epilepticus aredefined as either:
– Generalised convulsion lasting >30 minutes
– Multiple convulsions without regaining consciousness over 30min
However, start intervention for convulsion lasting >5min, as these may not stop spontaneously & the longer they continue, the difficult they are to control.
Common causes of CSE in children:
– Prolonged febrile convulsions
– Hypoglycemia
– Hypoxia
– Sepsis / Meningitis
– Low Na+, Mg+, Ca++
– Drug toxicity
– Raised ICP (consider NAI)
Assessment:
Airway + Oxygen
Breathing– is support needed
Circulation– vascular access?
Disability assessment/ GCS monitoring
Exposure– temp, rash, etc
Glucose, Gas- check
Start monitoring- SaO2, HR
Complications:
– Cardiac arrhythmias
– Hypertension
– Pulmonary oedema
– Hyperthermia
– Myoglobinuria
– DIC
Management:
– If expecting CSE, inform senior doctor
– Ensure correct timing of seizure onset
– Ask if any benzodiazepine given already
– Immediately perform ‘primary assessment’ of ABC, D, E & Glucose
– Treat any associated illness or metabolic abnormality rapidly
– Avoid hyponatremia, restrict fluids
– Consider interventions to reduce ICP
– Liaise early with anaesthetists & PICU