hello everyone this is dr. Peter Entebbe another edition of the head 70-minute this is something really exciting I want to talk about which is the case of a five year old Peter some recent data has been published to suggest that we may have a different algorithm for treating the child with a seizure so here's my question you're on Team fire drill is having a seizure SATs are 85 percent what do you do first well of course it's open up the airway with your two hands throwing oxygen what would you do next would you say a check a blood sugar or be given dose of benzodiazepine let's discuss that in - while you're thinking of your answer let's talk about this data that just came out this is from Kate Remington Maryanne gosh a hill at Harvard UCLA they essentially look at all the pediatric seizure patients over one year period that were brought in by EMS and so there were 770 pediatric to your patients in total and it turns out that of those 77084 of those about 14% were actively seizing upon arrival of EMS and so of those patients how many were actually hypoglycemic it may surprise you that the answer was only four this is only 0.5 percent of the total number of patients receiving actually had a low blood sugar now that's a very small number right in 2005 another study looked at about 6,000 patients also found a very similar number of about 0.8 percent so we're looking at the total number of patients who are actively seizing and you may run on the total number of children who actually may hypoglycemic due to those that the cause of those seizures may be very low and that's very important part of what we're about to discuss so I'm really excited to talk about Katey remick's and marrakesh a Hill's paper because it's a very nice algorithm to consider so if you walk up to a child actually seizing first thing you do open air where use your two hands nothing else jaw thrust chin lid child actively teasing the first thing you the dose of the benzodiazepine most people nowadays using madad and languages versed I am Rin in these two routes you can go to dose of 0.2 milligrams per kilogram and so first thing you do after the season is not check the blood sugar it actually give a dose of EndNote is a child not seizing here's the interesting part if the GCS is 15 they're saying no blood sugar at all which is very interesting okay now if you've given the midazolam already now the next step after the bedlam now you took a blood sugar if the GCS was not 15 and are a little altered then you took a blood sugar now once you check a blood sugar if it's normal in this study they're looking at over 60 is normal then you repeat midazolam if they're still seizing if the blood sugar is less than 60 here's where you give dextrose and of course you can use d-10 cradle-to-grave you can also use per your protocol b10 be 25 and be 50 again that's important here that you check a blood sugar after the benzo and you can repeat the midazolam if the butcherbird normal or you have to give dextrose if the blood Sugar's low again this is going to be very few pages they're going to come along this route right here most patients are going to require midazolam and stop or they'll need a repeat dose of midazolam so great information for the folks at Harbor UCLA remember use your hands first in the benzo second check a blood sugar depending on what the blocking of the ridge you'll need to repeat or you'll give dextrose and interestingly the patient looks perfectly fine and back to baseline they're recommending not to do a blood sugar and I agree with that again dr. Peter on Teddy for another edition of the heavy minute thank you