PE27.8 | Status Epilepticus — Summary & Reflection

KEY TAKEAWAYS

Status epilepticus (SE) is defined by ILAE 2015 as a seizure lasting ≥5 minutes (T1 — treat immediately) or ≥2 seizures without inter-ictal recovery; T2 = ≥30 minutes when neurological consequences begin. Pathophysiology: GABA-A receptor internalisation → progressive loss of inhibition → SE self-perpetuation; benzodiazepine efficacy decreases with seizure duration. Common causes in children: febrile illness, known epilepsy with missed AEDs, acute CNS infection, metabolic disturbance (hypoglycaemia — always exclude), toxins. Management is phased: Phase 1 (0–5 min) — ABC, O₂, glucose (dextrose 10%, 2–4 mL/kg IV); Phase 2 (5–20 min) — lorazepam IV 0.1 mg/kg (IV available) or buccal midazolam 0.2–0.3 mg/kg / rectal diazepam 0.5 mg/kg (no IV); Phase 3 (20–40 min, benzodiazepine failed) — levetiracetam IV 20–60 mg/kg, or fosphenytoin IV 15–20 mg PE/kg, or valproate IV 20–40 mg/kg; Phase 4 (>40 min, refractory) — ICU: midazolam or thiopentone infusion, intubation, continuous EEG. Phenytoin must not be given IM. Propofol is contraindicated in children <15 years.

REFLECT

Think back to the 3-year-old boy from our opening scenario — 14 minutes into a convulsive seizure, no IV access, oxygen saturation dropping. Reflect on: what is your immediate next action (before IV access is established)? What systematic error or hesitation in a non-specialist setting might lead to delay in giving the first benzodiazepine — and how would you design a quick training intervention to prevent it? Consider also the family experience: parents who have watched their child seize for 14 minutes are traumatised. After stabilisation, how do you give them an honest account of what happened, what was done, and what the next steps are — applying Kolb's reflective observation stage to your own performance in this emergency?