Pediatric Corner: Try these tips for pediatric seizures
Pediatric Corner
Try these tips for pediatric seizures
Do you know how to care for a pediatric patient who is actively seizing? "If a child has had a seizure at home, they will frequently seize again in the ED," warns Nancy Blake, RN, MN, CCRN, CNAA, director of critical care services at Children’s Hospital in Los Angeles.
Here are interventions to take if this occurs:
• Address appropriate initial management of the seizing child. Regardless of what caused the seizure, you must do three things: establish a patent airway, provide effective ventilation, and obtain vascular access for anticonvulsant administration, according to Laura M. Criddle, MS, RN, CS, CEN, CCRN, CNRN, emergency, trauma, and neurological clinical nurse specialist at Oregon Health and Sciences University in Portland. "If IV access is not readily available, diazepam may be administered rectally," she adds.
Criddle notes that anticonvulsant administration is essential, "since seizure activity places a tremendous metabolic demand on the body and brain that cannot be tolerated indefinitely," she says. She adds that prolonged status seizures can result in cerebral anoxia, hyperthermia, severe electrolyte disturbances, and rhabdomyolysis. "You need to make sure the child is in a safe position on a gurney, with the side rails up and padded," advises Blake. "They should be slightly on their side, so they won’t aspirate in case they vomit."
• Once the child is stabilized, investigate what caused the seizure. Criddle gives the following common seizure precipitants in pediatric patients: head injury, cerebral spinal fluid infections, cerebral-peritoneal shunt malfunction, fever, toxicities, and anoxic insults such as near drowning or suffocation. Other possible causes include tumors, arteriovenous malformations, brain abscesses and parasites, metabolic and electrolyte abnormalities, hypoglycemia, and genetic defects, she says. "However, a large proportion of pediatric seizures are idiopathic," Criddle adds.
• Give medication as appropriate. The child may be in status epilepticus and require medication to stop the seizures, says Blake. "If the patient is in status epilepticus, they can be given Ativan [Wyeth, Philadelphia] intravenously with careful monitoring of their airway and breathing," she advises. Blake warns that prolonged seizure activity could result in compromised air exchange. "The child could have brain injury as a result of decreased oxygen supply to the blood," she says.
• Make sure the airway is maintained. If a patient is about to have a seizure, make sure that he or she is in a position to keep their airway open, says Blake. "On their side is the best place for them to be," she says. Don’t try to force anything in their mouth or put your fingers in their mouth, or you could get bitten, Blake cautions.
• Be sure the environment is safe. Make sure there are no objects nearby that could harm the child, says Blake. "Padding the side rails [of the bed] of a known seizure patient or a patient in status epilepticus is a very good idea," she adds.
• Don’t hold down a child who is seizing. "You could actually cause more harm by doing this," Blake says.
• Educate parents about seizures. Although parents should be encouraged to obtain follow-up care, explain that just because a child has had one seizure doesn’t mean that he or she will have another, says Blake. A common misconception about pediatric seizures is that they are a result of some type of brain damage, Blake adds. "Many children have febrile seizures because they have a fever," she says.
• Bring fevers down with medication, not cold water. Acetaminophen and ibuprofen can be used to bring down a fever in children, Blake says. Children should not be put in a bathtub with cold water to bring down their fever, she advises. "The water should be at room temperature," adds Blake. "Putting a child in a cold bath can cause them to shiver, which would just raise the fever even higher."
• Don’t overmedicate children. Criddle warns that careful drug dosing is required for children with status seizures. "Medication is essential to stop the brain’s random firing," she says. "But overmedication puts the child at risk for respiratory and cardiovascular depression and may lead to unnecessary intubation." Paralytic drugs are occasionally given for prolonged seizures, but these limit only the body’s muscular response and do nothing to suppress cortical hyperactivity, Criddle notes.
• Determine levels of phenobarb. If a child has a known seizure disorder, it is important to get a phenobarb level, says Blake. "If they missed a dose or have been sick and unable to keep any medication down, they may just have a low phenobarb level," she explains. "If that is the case, they may just need an additional dose. Once the level is up, the seizures may stop."
Sources
For more information on pediatric seizures, contact:
• Nancy Blake, RN, MN, CCRN, CNAA, Director of Critical Care Services, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop 74, Los Angeles, CA 90027. Telephone: (323) 669-2164. Fax: (323) 953-7987. E-mail: [email protected].
• Laura M. Criddle, MS, RN, CS, CEN, CCRN, CNRN, Emergency, Trauma, and Neurological Clinical Nurse Specialist, Oregon Health & Sciences University, Mail Code UHS 8Q, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201. Telephone: (503) 494-1350. Fax: (503) 494-7441. E-mail: [email protected].
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