Emergency management of convulsions in children

Febrile convulsions

Diagnosis based on presence of fever, short duration and no clinical evidence of CNS pathology.

Clinical features

The commonest cause is an URTI (e.g. the common cold or similar viral syndrome).

About 5 per 100 incidences in children worldwide.

Rare under 6 months and over 5 years.

Commonest age range 9-20 months.

Recurrent in up to 50 % of children.

Consider meningitis and lumbar puncture after first convulsion if under 2 years or cause of fever not obvious.

Epilepsy develops in about 2-3% of such children. To provide reassurance and comfort to parents is vital as many guardians may become apprehensive.

Management of the convulsion (if prolonged >15 minutes) which is similar for acute epileptic attacks or status epilecticus:

Undress the child to singlet and underpants to keep cool.

Maintain the airway and prevent injury.

Place patient chest down with head turned to one side. The recovery position is better.

Oxygen 8 L/min by mask.

Give midazolam or diazepam. There are several routes but the more effective ones are given by injectable routes. Oral routes must be avoided.

Meningitis or encephalitis

Diagnosing meningitis and encephalitis requires a high level of clinical awareness and watchfulness for the infective problem that appears more serious than normal.

Bacterial meningitis

Bacterial meningitis is basically also a childhood infection. Neonates and children aged 6-12 months are at the greatest risk. Meningococcal disease can take the form of either meningitis or sepsis (meningococcaemia) or both. Most cases begin as sepsis, usually via the nasopharynx.

Treatment for suspected meningitis:

First-oxygen and IV access:

Take blood for culture (within 30 minutes of assessment).

For child give bolus of 10-20 ml/kg of Normal Saline.

Admit to hospital for lumbar puncture.

Dexamethasone 0.1s mg/kg up to 10 mg IV.

Ceftriaxone 100 mg/kg up to 4 g, IV stat Intramuscular or Intravenous routes then daily. But the antibiotic regimen may need to be changed based on culture and sensitivity report.

Meningococcaemia

Treatment is urgent, if sepsis suspected (e.g. petechial or purpuric rash on trunk and limbs). Treatment should be given before reaching hospital according to the following plans.

Antibiotics

Benzylpenicillin may be given at a dose of 6o mg/kg IV (max. 1.8 g) initially while urgent arrangements for hospitalization are pursued. Give I M, if IV access is not possible or Ceftriaxone 100 mg/kg IV or IM (max. 4 g) stat IM.

A simple plan for children (prehospital) with Benzylpenicillin with suspected Meningocooccimea:

Infants <1 year: 300 mg IV or IM; 1-9 years: 6oo mg; 10 years: 1200 mg.

Prophylactic ciprofloxacin or ceftriaxone should be considered for nearly everyone the child has been in contact with.

(Reprint)

 

Emergency management of convulsions in children

Febrile convulsions Diagnosis based on presence of fever, short duration and no clinical evidence of CNS pathology. Clinical features The commonest cause is an URTI (e.g. the common cold or similar viral syndrome). About 5 per 100 incidences in children worldwide. Rare under 6 months and over 5 years. Commonest age range 9-20 months. Recurrent in up to 50 % of children. Consider meningitis and lumbar puncture after first convulsion if under 2 years or cause of fever not obvious. Epilepsy develops in about 2-3% of such children. To provide reassurance and comfort to parents is vital as many guardians may become apprehensive. Management of the convulsion (if prolonged 15 minutes) which is similar for acute epileptic attacks or status epilecticus: Undress the child to singlet and underpants to keep cool. Maintain the airway and prevent injury. Place patient chest down with head turned to one side. The recovery position is better. Oxygen 8 L/min by mask. Give midazolam or diazepam. There are several routes but the more effective ones are given by injectable routes. Oral routes must be avoided. Meningitis or encephalitis Diagnosing meningitis and encephalitis requires a high level of clinical awareness and watchfulness for the infective problem that appears more serious than normal. Bacterial meningitis Bacterial meningitis is basically also a childhood infection. Neonates and children aged 6-12 months are at the greatest risk. Meningococcal disease can take the form of either meningitis or sepsis (meningococcaemia) or both. Most cases begin as sepsis, usually via the nasopharynx. Treatment for suspected meningitis: First-oxygen and IV access: Take blood for culture (within 30 minutes of assessment). For child give bolus of 10-20 ml/kg of Normal Saline. Admit to hospital for lumbar puncture. Dexamethasone 0.1s mg/kg up to 10 mg IV. Ceftriaxone 100 mg/kg up to 4 g, IV stat Intramuscular or Intravenous routes then daily. But the antibiotic regimen may need to be changed based on culture and sensitivity report. Meningococcaemia Treatment is urgent, if sepsis suspected (e.g. petechial or purpuric rash on trunk and limbs). Treatment should be given before reaching hospital according to the following plans. Antibiotics Benzylpenicillin may be given at a dose of 6o mg/kg IV (max. 1.8 g) initially while urgent arrangements for hospitalization are pursued. Give I M, if IV access is not possible or Ceftriaxone 100 mg/kg IV or IM (max. 4 g) stat IM. A simple plan for children (prehospital) with Benzylpenicillin with suspected Meningocooccimea: Infants 1 year: 300 mg IV or IM; 1-9 years: 6oo mg; 10 years: 1200 mg. Prophylactic ciprofloxacin or ceftriaxone should be considered for nearly everyone the child has been in contact with. (Reprint)