Lecture Notes: Seizure Management in Pediatric Patients

Introduction

• Presenter: Dr. Peter Entebbe
• Focus: Case study of a 5-year-old child with seizures
• Recent data suggests a new algorithm for treating seizures in children

Initial Response to a Seizing Child

• Airway Management
  • Open the airway using hands: jaw thrust and chin lift
  • Administer oxygen
• Next Steps
  • Options: Check blood sugar or give benzodiazepine

Recent Study Findings

• Researchers: Kate Remington, Maryanne Gosh-A-Hill at Harvard UCLA
• Study overview:
  • Examined pediatric seizure patients over one year
  • Sample size: 770 pediatric seizure patients
  • Findings:
    • 14% were actively seizing upon EMS arrival
    • Only 0.5% were hypoglycemic (4 out of 770)
• Conclusion: Hypoglycemia is a rare cause of seizures

Recommended Algorithm (from the study)

• Step 1: Airway Management
  • Use hands to open airway: jaw thrust, chin lift
• Step 2: Benzodiazepine Administration
  • Administer Midazolam (Versed)
  • Dosage: 0.2 mg/kg, IM or IN route
• Step 3: Blood Sugar Check
  • If the child is still altered after Midazolam, check blood sugar
  • Criteria:
    • Normal if above 60 mg/dL
    • If less than 60 mg/dL, administer dextrose
• Step 4: Repeat Midazolam or Dextrose
  • If blood sugar is normal and child is still seizing, repeat Midazolam
  • If blood sugar is low, give dextrose (options: D10, D25, D50 per protocol)

Key Points

• Most patients will respond to Midazolam and may require a repeat dose
• If the child’s Glasgow Coma Scale (GCS) is 15 and back to baseline, no blood sugar test is needed
• Emphasis on using hands first, benzodiazepine second, and blood sugar check third

Conclusion

• Important insights from the Harvard UCLA study
• New protocol focuses on minimizing unnecessary blood sugar checks
• Dr. Peter Entebbe emphasizes practical application of these findings
• End of the 70-Minute presentation series