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Medical

Pediatric SEIZURE

Signs and Symptoms: Differential Diagnosis by Age:
• Decreased Mental Status Less Than 3 Years Old:
• Seizure Activity • Trauma
• Somnolence • Fever
• Incontinence • Infection
• Evidence of Trauma • Birth Injury
• Loss of Consciousness • Drug/Toxin
• Oral Injuries (e.g., Tongue, • Metabolic: Hypoglycemia/Electrolyte Abnormality
Buccal) More Than 3 Years Old:
• Trauma, Infection, Brain Degenerative Disease
Universal Patient Care Guideline
O2 (if Hypoxemic) LORAZEPAM 0.05-0.1mg/kg IV
Continued from: IV/IO Guideline Max 4mg, (preferred medication)
Tactical Evacuation Guideline Cardiac Monitor OR
Blood Glucose MIDAZOLAM 0.2mg/kg IM
Patient Safety (ensure secured to litter) (if NO IV access)
Evidence of Malnourishment? Having Active Seizure? YES Consider:
NO, Postictal
NO YES Blood Glucose: <6 65? Levetiracetam (Keppra) 20mg/kg
as a single dose
5
Thiamine 25mg IV/IM YES NO BLOOD GLUCOSE ANALYSIS
Evidence of Significant Trauma?
25% Dextrose 2mL/kg IV YES Seizure Stopped? NO
OR NO SPINAL IMMOBILIZATION
Glucagon 0.05mg/kg IM PROCEDURE YES

(If NO IV Access) Consider: Pediatric AIRWAY
NO Glucose: >65? Consider: Pediatric HEAD INJURY May Repeat Anticonvulsants Twice
YES (then must establish Definitive Airway
Recurrence of Seizure? Continuously Monitor and Control prior to subsequent doses)
AIRWAY Guideline for RSI
Reassess q5min
q
YES NO (anticipate recurrence)
Restart guideline at: TRAUMA
Having Active Seizure? When appropriate, return to: • Pediatric HEAD INJURY
Tactical Evacuation Guideline FEBRILE SEIZURE
• Non-Invasive Cooling Measures
• Tylenol 15mg/kg PO as able
Pearls:
• Status epilepticus defined as seizure >5min or two or more successive seizures without a period of
consciousness/recovery. This is a true emergency requiring rapid treatment and transport to nearest suitable
medical treatment facility. Ensure adequate airway control is established if medication is administered.
• Paralysis for airway control does not stop seizure activity–only hides it. Seizure is a CNS electrical
phenomenon and damage is still being done even when no muscular activity seen due to paralysis.
• Be prepared to assist with ventilations with the use of Lorazepam/Midazolam. If airway controlled and
ventilating well–may give total of 4 doses of Lorazepam.
• MAX DOSES:
o LORAZEPAM = 4mg/dose, D25 = 25mL/dose, GLUCAGON = 1mg/dose

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