Post-ictal State, S/P Seizure Event part 2

Standard Approach

First steps

• The first step is to ensure that a child with seizure activity is maintaining his or her airway. Once this is ensured, further measures can be taken.

• Establishing IV access is important not only for medications to stop the seizure, but also to administer glucose, if needed, as hypoglycemia is a common cause of seizures in young children.

• Checking a bedside glucose is vital information for prehospital care as well as for care in the emergency department. • Note that a febrile seizure may be the first indication the child is ill.

• Febrile seizures in children should last less than 5 minutes, but can last as long as 15 minutes and still be considered a simple febrile seizure. As this child demonstrates, a postictal period follows. The suggested prehospital approach includes:

• Establish an airway: if patient is maintaining, ensure adequate respirations and saturations. The best way to manage the airway is to stop any ongoing seizures.

• Establish IV access if seizing on arrival, but give first dose of benzodiazepine IN or IM, or rectally if using diazepam.

• Check a bedside glucose

• First-line treatment for persistent seizure activity is a benzodiazepine. This may be repeated if continued seizure activity for 5 minutes after administration.

Suggested References

• Febrile seizures

• Pediatric febrile seizure