BASICS
The most common neurological emergency of childhood
What are seizures
This category of seizures includes: single seizure in 24 hours, generalized in nature, lasting <15min, occurring ages 6 months - 5 years.
What are benign simple febrile seizures
Current CHOP (2021) guidelines for pediatric patients >60 days recommend this medication at this dose as a first line agent if an actively seizing pediatric patient has IV access
What is Lorazepam 0.1mg/kg
Which of the following scenarios is most consistent with an acute simple febrile seizure?
C. An 8-month old infant with a rectal temperature of 39°C who presents after having a generalized tonic-clonic seizure lasting 5 minutes
The most common category of pediatric seizures
What are benign simple febrile seizures
This category of seizures includes: multiple seizures in 24 hours, focal or generalized in nature, can be prolonged, occur at any age
What are complex febrile seizures
If you are unable to establish IV access within 5min, then these 5 routes can be considered.
What are:
IO
IM
Buccal
Intra-nasal
Rectal
Which of the following is most characteristic of a complex febrile seizure?
A. Convulsions are focal in nature
These are the three categories of pediatric seizures.
What are:
Simple febrile seizures
Complex febrile seizures
Non-febrile seizures
This occurs when seizures last >5 minutes or involve consecutive seizures without a return to baseline in between
What is status epilepticus
Current CHOP (2021) guidelines for pediatric patients >60 days recommend this medication at this dose as a first line agent if an actively seizing pediatric patient is without IV access
What is:
Midazolam (buccal 0.3mg/kg or IM 0.2mg/kg)
Which of the following statements is true regarding febrile seizures?
D. Treatment with long-term anticonvulsants does not lower the long-term risk of developing epilepsy
The most common mimic of seizures in the 6 - 18 month range.
What are:
Breath holding spells
This occurs when seizures continue after administration of two appropriately dosed anti-seizure medications
What is refractory status epilepticus
Current (2021) CHOP guidelines for pediatric patients >60 days recommend one of these two medications be used as 2nd line agents if a pediatric patient's seizure does not stop with benzodiazepines.
What are:
Fosphenytoin
Levetiracetam
A 14-month-old boy presents to the emergency department after an accidental isoniazid overdose. Shortly after arrival, he begins to seize. Which of the following medications is the next best step in management?
D. Pyridoxine
This cause of non-febrile seizures occurs most commonly in children under 6 months of age and is related to their diet.
What is hyponatremia secondary to formula over-dilution
This is a movement disorder associated with GERD in pediatric patients, occasionally confused for seizure like activity
Current (2021) CHOP guidelines for pediatric patients >60 days recommend one of these three medications be added as 3rd line agents if a pediatric patient's seizure does not stop following 2nd line agent.
What are:
Valproate
Phenobarbitol
Ketamine
An 8-month old child presents to the emergency department having generalized tonic clonic seizure activity. Her mother reports that she is bottle-fed and has been diluting her formula secondary to financial strains. Her serum sodium is found to be 120 mEq/L. She weighs 8 kilograms. She is actively seizing. What is the most appropriate dose of 3% hypertonic saline to administer the patient?
A. 16 mL of 3% hypertonic saline
(Initial bolus of 2–6 mL/kg given over 10–30 minutes)