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Pediatric emergency medicine trisk 362

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(e.g., pentobarbital to 15 mg/kg load, then mg/kg/hr starting dose), benzodiazepines (e.g., continuous infusion midazolam 0.2 mg/kg load, then 0.05 to 0.2 mg/kg/hr), or continuous infusion propofol (3 to mg/kg load, then to 15 mg/kg/hr) Patients requiring general anesthetics need to be intubated (if not already done) and need continuous EEG monitoring The level of anesthesia should be titrated to maintain either a flat-line or burst-suppression pattern on the EEG The anesthesia can be then withdrawn slowly to see if any electrical seizure activity persists It is important to note that prior CNS insult or seizure disorder accounts for a high proportion of pediatric status epilepticus cases Seizure management may be very complex and may involve multiple AEDs; therefore, a seizure management plan should be developed as rapidly as possible in consultation with a pediatric neurologist, either preemptively or during an SE episode SPECIAL CONSIDERATIONS Febrile Seizures Febrile seizures are the most common convulsive disorder in young children, occurring in 2% to 5% of the population Most clinicians define a febrile seizure as a seizure occurring between months and years of age that is associated with a fever (temperature higher than 38°C [100.4°F]), but without the evidence of intracranial infection or other defined cause or neurologic disease Some clinicians use years as an upper age limit for febrile seizures, following the International League Against Epilepsy (ILAE) from 1993 defining the age cutoff of month to years Febrile seizures can be of any type, but most commonly, they are generalized tonic-clonic seizures They are usually self-limited and last for only a few minutes Febrile seizures are classified as simple when lasted less than 15 minutes, are generalized, and occur only once during a 24-hour period (two seizures within a time period of

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