Ncpg Seizures

  • View
    213

  • Download
    0

Embed Size (px)

Text of Ncpg Seizures

  • 8/14/2019 Ncpg Seizures

    1/18

    SEIZURES

    Dr Jonny Taitz, FRACP

    Geschn Paediatrician

    Sept 2003

  • 8/14/2019 Ncpg Seizures

    2/18

    2

    Introduction

    Common

    8% of children will have a seizure by

    15 years of age

  • 8/14/2019 Ncpg Seizures

    3/18

    3

    Seizure

    Sudden

    Attack of altered behaviour

    LOC

    abnormal sensation, automaticfunction

  • 8/14/2019 Ncpg Seizures

    4/18

    4

    Most Common

    Tonic (stiffening)

    Clonic (jerking)

    AbsenceMyoclonic

    Atonic

    Focal

    MOST ARE BRIEF

    TERMINATE SPONTANEOUSLY

    50% in childhood = febrile convulsion

  • 8/14/2019 Ncpg Seizures

    5/18

    5

    Which seizures do we

    treat?> 5 minutes brain hypoxiaStatus epilepticus

    Generalised seizures > 30 minsOR

    Repeated convulsions > 30 mins with NO

    recovery & consciousness betweenconvulsions

  • 8/14/2019 Ncpg Seizures

    6/18

    6

    ComplicationsAge related > 3 yr - 6%

    < 1 yr - 30%

    - Long term epilepsy

    - Motor problems

    - Learning &behavioural problems

    5% mortality (1/20)

  • 8/14/2019 Ncpg Seizures

    7/18

    7

    Guidelines aim JHH SHC

    CHW

    clear, succint guidelines inthe care of acute seizures

    Many different anticonvulsants

    Different routes of administration Intravenous Intramuscular Rectal

    Oral

  • 8/14/2019 Ncpg Seizures

    8/18

    8

    ImportantSeizures < 15 minutes muchmore likely to respond to Rx

    than seizures > 15 minutes

  • 8/14/2019 Ncpg Seizures

    9/18

    9

    History? Febrile illnessUnderlying CNS problems

    History of epilepsyHead trauma

    toxin ingestion

    1assessment

    ABC

  • 8/14/2019 Ncpg Seizures

    10/18

    10

    Specific features on examAirway intubationBreathing hypoventilation, aspiration,

    O2, mask ventilation

    Circulation shock, fluid bolusesNeurological focal signs, LOC, RIP, asymmetrical seizures

    Underlying illness trauma, meningitis,head injury, metabolic

    abnormalities

  • 8/14/2019 Ncpg Seizures

    11/18

    11

    Management

    Priority no 1: ABC

    Airway(Control seizures control airway)

    Breathing Effective and efficient

    All fitting kids high flow O2

    NB: repeated seizures

    high dose anticonvulsants

    Circulation}

    Resp

    depression? Intubate +ventilate Circulation

    Rx shock

    Fluid Boluses

  • 8/14/2019 Ncpg Seizures

    12/18

    12

    Management (contd)

    NEVER FORGET!!! GLUCOSE + BP

    Hypoglycaemia Rx 5mls/kg 10% Dextrose

    Hypertension Antihypertensives:

    (I.e nifedipine, hydralazine)

  • 8/14/2019 Ncpg Seizures

    13/18

    13

    Questions to ask

    Do I have vascular access?

    What anticonvulsants areavailable?

    How many minutes has the

    child been fitting?

  • 8/14/2019 Ncpg Seizures

    14/18

    14

    Vascular AccessYes NoDiazepam 0.25mg/kg IVI Diazepam 0.25mg/kg PR

    Or Midazolam 0.15mg/kg IVI Or Midazolam 0.15mg/kg IMI

    5 Access

    Repeat Diazepam IVIOr Midazolam IVI

    No

    10

    LOAD repeat

    Phenytoin 20 mg/kg IVI Diazepam or Midazolamor Phenobarb 20mg/kg IVI

    20

    Rapid sequence induction Paraldehyde 0.4mg/kg PR

    Thiopentone, Atropine, Dilute 50:50 (olive oil)

    Suxemethonium

    Supportivemeasures

    ABC

  • 8/14/2019 Ncpg Seizures

    15/18

    15

    A little more on

    anticonvulsantsDiazepam Effective first line in 80%

    Rectal admin therapeutic levels 5minutes

    Rapid seizure control (80%)

    S/E 9% risk of respiratory depressionHigher in children with CNS abnormalities

  • 8/14/2019 Ncpg Seizures

    16/18

    16

    A little more on

    anticonvulsantsMidazolam NSW Ambulance drug of first choice in

    status epilepticus (IMI)

    Will stop majority of seizures within 1minute (IVI)

    Takes longer when used IM (approx 5-10 mins)

    Intransal midazolamMore info required before recommending it

  • 8/14/2019 Ncpg Seizures

    17/18

    17

    Midazolam (contd)

    Paraldehyde Used since 1930s

    Very dangerous IVI Well tolerated rectally Rapid onset of seizure control Less respiratory depression than

    Benzodiazepines Smells

  • 8/14/2019 Ncpg Seizures

    18/18

    18

    Questions