The document provides information on pediatric seizures from the Illinois Emergency Medical Services for Children program. It discusses the collaborative program between the Illinois Department of Public Health and Loyola University Health System to improve pediatric emergency care in the state. A statewide quality improvement project found opportunities to improve protocols and management of seizures. The document provides information on assessing and managing different types of pediatric seizures encountered in pre-hospital and emergency department settings, including febrile seizures, first unprovoked seizures, and status epilepticus. It emphasizes history taking, vital sign monitoring, seizure and airway precautions, and guidelines for diagnostic testing.
The document discusses pediatric hyperglycemia and diabetic ketoacidosis (DKA). It notes that DKA is the most common cause of death in children with diabetes globally due to lack of access to insulin or improper insulin use. Risk factors for DKA include young age, poor diabetes control, missed insulin injections, and infection. The document outlines the pathophysiology of hyperglycemia and DKA and provides guidelines for assessment, management, complications, education, and resources regarding pediatric patients presenting with these conditions.
'Overview of the Palliative Care Service at Our Lady’s Children’s Hospital, C...Irish Hospice Foundation
'Overview of the Palliative Care Service at Our Lady’s Children’s Hospital, Crumlin' (Presentation at the Maternity and Neonatal Network Meeting, April 2015) [MNN 12]
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
The document discusses the Integrated Management of Childhood Illness (IMCI) strategy developed by the World Health Organization and UNICEF. IMCI aims to reduce childhood mortality by integrating the case management of the most common causes of death for children under 5, such as pneumonia, diarrhea, and malaria. It provides a standardized process for healthcare workers to assess, classify, treat, and counsel children with multiple conditions. The six major steps of IMCI's integrated case management process are outlined. IMCI tools like the chart booklet, wall posters, and case recording forms are also introduced to help healthcare workers implement the strategy.
Seth Philip DeVries is a board certified pediatric neurologist practicing at Helen DeVos Children's Hospital in Grand Rapids, Michigan. He completed medical school at Indiana University and residencies in pediatrics and child neurology, with additional fellowship training in clinical neurophysiology. His clinical interests include pediatric epilepsy, status epilepticus in newborns, and medication-resistant epilepsy. He is involved in teaching residents, quality improvement initiatives, and telemedicine programs to expand access to epilepsy care.
early intervention in high risk infants.pptxibtesaam huma
Early Intervention in High Risk Infants
-Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Objectives
By the end of the seminar one would know
What is high risk infants?
Determinants of high risk infants
Monthwise neurodevelopment of infants in gestational age
Early intervention
General NICU guidelines for high risk infants
Recent advances
What is High Risk Infant?
A High risk infant is broadly defined as one who requires more than the standard monitoring and care offered to a healthy term newborn infant.
According to American Academy of Pediatrics, High risk infant may be defined as
Preterm Infant
Infant with special healthcare needs or dependence on technology
Infant at risk because of family issues.
Infant with anticipated early death.
High-Risk Clinical Signs
At 4 months of age, hypertonicity of the trunk or extremities is recognized as a high-risk clinical sign.
Less alternate kicking movement compared with typically developing LBW infant.
Abnormalities of kicking described by Prechtl as “cramped-synchronized,” that is, limited in variety and characterized by “rigid movement with all limbs and the trunk contracting and relaxing almost simultaneously,”
Preterm Infant
Preterm infant is the infant which is born before 36 weeks of gestation
Usually preterm infant have low birth weight i.e. less than 2.5 kgs
Determinants of High Risk Infant
Biological Risk
Attributed to medical/physical condition presence of
Asphyxia
Neonatal seizures
Prenatal exposure to drugs or alcohol
Brain-lesions
Low birth weight
Established Risk
Associated with diagnosis that is clearly established like,
Congenital malformation
Chromosomal abnormalities
CNS disorders
Metabolic disease.
Environmental & social risk
Refers to competency in parenting roles and factors in family dynamics
Suboptimal levels of stimulation and interaction in NICU
Inadequate parent-infant attachment
Insufficient educational preparation for caregiver roles
Meager financial resources of parents
Limited or absent family support to assist in taking care of and nurturing the infants in home environment.
The systems of infants develop in their stipulated time during gestational period prenatal or preterm results in specific injury
Commonest condition which requires early intervention
Newborn Maturity Rating—Ballard Score
Widely adopted because of the time efficiency
Ballard instrument involves only six physical and six neurological criteria, with a 0 to 5 scale and a maturity rating
designed to be used for neonates (20 to 44 weeks gestation) from birth through 3 days of age and has demonstrated concurrent validity with the Dubowitz gestational age calculation tool.
Neonatal Behavioral Assessment Scale
30- to 45-minute examination consists of observing, eliciting, and scoring 28 behavioral items on a 9-point scale and 18 reflex items on a 4-point scale
Six behavioral state categories are outlined in the NBAS: deep sleep,
The Pediatric Assessment Triangle (PAT) is a novel approach for the rapid evaluation of children in emergency situations. The PAT uses only visual and auditory cues to assess a child's appearance, work of breathing, and circulation to the skin. This allows clinicians to quickly determine if a child is stable or unstable, and to identify the general category of physiological abnormality. The PAT promotes standardized communication among healthcare providers and helps prioritize critical treatments in emergency pediatric assessments.
The document discusses transitions from pediatric to adult healthcare for young adults with neurologic conditions like Lennox-Gastaut syndrome. It notes that only 40% of youth discuss transition plans with providers. The document outlines current barriers to transition including unwillingness to change providers, lack of experienced adult providers, and differences between pediatric and adult systems. It emphasizes the importance of setting expectations to drive healthcare change and improving transition processes and outcomes.
The document discusses pediatric hyperglycemia and diabetic ketoacidosis (DKA). It notes that DKA is the most common cause of death in children with diabetes globally due to lack of access to insulin or improper insulin use. Risk factors for DKA include young age, poor diabetes control, missed insulin injections, and infection. The document outlines the pathophysiology of hyperglycemia and DKA and provides guidelines for assessment, management, complications, education, and resources regarding pediatric patients presenting with these conditions.
'Overview of the Palliative Care Service at Our Lady’s Children’s Hospital, C...Irish Hospice Foundation
'Overview of the Palliative Care Service at Our Lady’s Children’s Hospital, Crumlin' (Presentation at the Maternity and Neonatal Network Meeting, April 2015) [MNN 12]
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
The document discusses the Integrated Management of Childhood Illness (IMCI) strategy developed by the World Health Organization and UNICEF. IMCI aims to reduce childhood mortality by integrating the case management of the most common causes of death for children under 5, such as pneumonia, diarrhea, and malaria. It provides a standardized process for healthcare workers to assess, classify, treat, and counsel children with multiple conditions. The six major steps of IMCI's integrated case management process are outlined. IMCI tools like the chart booklet, wall posters, and case recording forms are also introduced to help healthcare workers implement the strategy.
Seth Philip DeVries is a board certified pediatric neurologist practicing at Helen DeVos Children's Hospital in Grand Rapids, Michigan. He completed medical school at Indiana University and residencies in pediatrics and child neurology, with additional fellowship training in clinical neurophysiology. His clinical interests include pediatric epilepsy, status epilepticus in newborns, and medication-resistant epilepsy. He is involved in teaching residents, quality improvement initiatives, and telemedicine programs to expand access to epilepsy care.
early intervention in high risk infants.pptxibtesaam huma
Early Intervention in High Risk Infants
-Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Objectives
By the end of the seminar one would know
What is high risk infants?
Determinants of high risk infants
Monthwise neurodevelopment of infants in gestational age
Early intervention
General NICU guidelines for high risk infants
Recent advances
What is High Risk Infant?
A High risk infant is broadly defined as one who requires more than the standard monitoring and care offered to a healthy term newborn infant.
According to American Academy of Pediatrics, High risk infant may be defined as
Preterm Infant
Infant with special healthcare needs or dependence on technology
Infant at risk because of family issues.
Infant with anticipated early death.
High-Risk Clinical Signs
At 4 months of age, hypertonicity of the trunk or extremities is recognized as a high-risk clinical sign.
Less alternate kicking movement compared with typically developing LBW infant.
Abnormalities of kicking described by Prechtl as “cramped-synchronized,” that is, limited in variety and characterized by “rigid movement with all limbs and the trunk contracting and relaxing almost simultaneously,”
Preterm Infant
Preterm infant is the infant which is born before 36 weeks of gestation
Usually preterm infant have low birth weight i.e. less than 2.5 kgs
Determinants of High Risk Infant
Biological Risk
Attributed to medical/physical condition presence of
Asphyxia
Neonatal seizures
Prenatal exposure to drugs or alcohol
Brain-lesions
Low birth weight
Established Risk
Associated with diagnosis that is clearly established like,
Congenital malformation
Chromosomal abnormalities
CNS disorders
Metabolic disease.
Environmental & social risk
Refers to competency in parenting roles and factors in family dynamics
Suboptimal levels of stimulation and interaction in NICU
Inadequate parent-infant attachment
Insufficient educational preparation for caregiver roles
Meager financial resources of parents
Limited or absent family support to assist in taking care of and nurturing the infants in home environment.
The systems of infants develop in their stipulated time during gestational period prenatal or preterm results in specific injury
Commonest condition which requires early intervention
Newborn Maturity Rating—Ballard Score
Widely adopted because of the time efficiency
Ballard instrument involves only six physical and six neurological criteria, with a 0 to 5 scale and a maturity rating
designed to be used for neonates (20 to 44 weeks gestation) from birth through 3 days of age and has demonstrated concurrent validity with the Dubowitz gestational age calculation tool.
Neonatal Behavioral Assessment Scale
30- to 45-minute examination consists of observing, eliciting, and scoring 28 behavioral items on a 9-point scale and 18 reflex items on a 4-point scale
Six behavioral state categories are outlined in the NBAS: deep sleep,
The Pediatric Assessment Triangle (PAT) is a novel approach for the rapid evaluation of children in emergency situations. The PAT uses only visual and auditory cues to assess a child's appearance, work of breathing, and circulation to the skin. This allows clinicians to quickly determine if a child is stable or unstable, and to identify the general category of physiological abnormality. The PAT promotes standardized communication among healthcare providers and helps prioritize critical treatments in emergency pediatric assessments.
The document discusses transitions from pediatric to adult healthcare for young adults with neurologic conditions like Lennox-Gastaut syndrome. It notes that only 40% of youth discuss transition plans with providers. The document outlines current barriers to transition including unwillingness to change providers, lack of experienced adult providers, and differences between pediatric and adult systems. It emphasizes the importance of setting expectations to drive healthcare change and improving transition processes and outcomes.
Systematic approach to the seriously ill or injured childMahmoud Khedr
This document provides guidance on systematically assessing and treating critically ill or injured children. It begins by outlining the objectives of utilizing appropriate assessment techniques to rapidly identify treatment priorities. It then describes the Pediatric Assessment Triangle (PAT) framework, which uses appearance, work of breathing, and skin circulation to evaluate a child's condition within seconds. The document emphasizes that any abnormality in the PAT denotes an unstable child requiring intervention. It provides details on evaluating each component of the PAT and categorizing the child's condition to dictate the type and urgency of treatment needed. Finally, it stresses intervening immediately for life-threatening problems by following ABC protocols, activating emergency response, and focusing on stabilization over detailed diagnosis in critically ill children.
1) The document discusses IMCI (Integrated Management of Childhood Illnesses), a global strategy to improve the health of children under 5 and reduce child mortality from major diseases.
2) IMCI aims to improve the skills of health workers in managing common childhood illnesses, strengthen health systems, and encourage better family/community health practices like breastfeeding.
3) Key components of IMCI include assessing, classifying, treating, and counseling for sick children, with illnesses categorized as red (severe), yellow (needs follow-up), or green (mild). General danger signs that require urgent referral are also outlined.
Outpatient Follow Up Of Premature Infants, by Dr. Khaled El-Atawi A/Consultan...mohamed osama hussein
This document discusses guidelines for outpatient follow up of premature infants after discharge from the hospital. It recommends that infants born weighing less than 1500 grams or with certain medical conditions receive follow up care. The optimal follow up includes assessing growth and development, providing primary care, addressing any unresolved medical issues, developing a home care plan, and arranging support services. Follow up appointments should be scheduled with the primary care physician and any specialists involved in the infant's care. During visits, growth, nutrition, neurodevelopment, and general health should be evaluated based on the infant's adjusted age to account for prematurity. Appropriate screening tests can help identify infants at risk for developmental delays.
TEST BANK For Principles of Pediatric Nursing Caring for Children, 8th Editio...rightmanforbloodline
TEST BANK For Principles of Pediatric Nursing Caring for Children, 8th Edition by Kay Cowen; Laura Wisely, Verified Chapters 1 - 31, Complete Newest Version
The document discusses newborn screening for metabolic disorders. It describes Tyler Wayne's story who died from undiagnosed galactosemia. Metabolic disorders can cause damage if not detected early through newborn screening. The document outlines the benefits of newborn screening such as early detection and treatment before symptoms appear. It describes how tandem mass spectrometry can screen for over 50 treatable disorders simultaneously and efficiently.
The document discusses newborn screening for metabolic disorders using tandem mass spectrometry (MS/MS). It begins with the story of Tyler Wayne who died from undiagnosed galactosemia. It then explains that MS/MS allows for early detection of treatable metabolic disorders before symptoms appear, preventing complications. The document outlines the process and benefits of newborn screening as well as the status of screening programs in various countries including the UAE.
The document discusses newborn screening for metabolic disorders. It describes Tyler Wayne's story who died from undiagnosed galactosemia. Metabolic disorders can cause damage if not detected early through newborn screening. The document outlines the benefits of newborn screening such as early detection and treatment before symptoms appear. It describes how tandem mass spectrometry can screen for over 50 treatable disorders simultaneously.
The document discusses human life cycles and survival from birth, focusing on birth asphyxia. It summarizes that birth asphyxia is a major cause of neonatal death and neurological disability. Interventions are needed during the antenatal, intrapartum, and postnatal periods to improve survival and prevent complications of birth asphyxia. These include good antenatal care, skilled birth attendance, emergency obstetric care, newborn resuscitation, and community-based newborn care.
Introduction who integrated management_of_childhood_illness-convertedDrHassanAliIndhoy
The document summarizes the World Health Organization's Integrated Management of Childhood Illness (IMCI) strategy. IMCI integrates the case management of common childhood illnesses, especially the leading causes of death for children under 5. It provides standardized guidelines and tools for healthcare workers to assess, classify, treat and counsel children with multiple conditions. The goal is to improve the quality of care for sick children and reduce mortality rates through an integrated approach to treating the most common illnesses together.
Conferencia de la Dra. Joanne Wolfe sobre Cuidados Paliativos Pediátricos, en...PrincipitoJuanPi
This document summarizes a presentation on pediatric palliative care given by Dr. Joanne Wolfe. It discusses the scope of pediatric palliative care needs, including common diagnoses, symptoms, and technologies used to treat children with life-threatening illnesses. It also describes the suffering experienced by patients and their families from physical, psychological, social, and existential distress. Additionally, it outlines the Boston Pediatric Palliative Care experience, including the interdisciplinary team approach, strategies used, and outcomes demonstrating improved symptom management, family satisfaction, and reduced healthcare utilization. Finally, it discusses adapting the pediatric palliative care model to low and middle income countries by assessing available resources and integration with local care providers.
The document discusses epilepsy and seizures, providing information on:
- What epilepsy is and how it differs from seizures
- Common causes of epilepsy including head trauma, brain tumors, and genetics
- What happens during different types of seizures
- Strategies for responding appropriately to seizures, such as staying calm, protecting the person's head, and calling for medical help if the seizure lasts more than 5 minutes
- Effective strategies for working with students who have epilepsy, including understanding their needs, clear communication with parents and schools, and teaching life skills.
This document provides a case definition and guidelines for collecting, analyzing, and presenting data on neonatal encephalopathy as an adverse event following maternal immunization. It defines neonatal encephalopathy as an abnormal level of alertness or seizures in an infant born at or after 35 weeks gestation, potentially due to hypoxia/ischemia, metabolic disturbance, or infection. The definition aims to improve comparability of vaccine safety data across different healthcare settings and regions. It was developed through consensus of an expert working group using a literature review on neonatal encephalopathy and adverse events following immunization.
IMCI POWER POINT PRESENTATIONS-2-5 YEARS (2).pptkkean6089
Check for general danger signs. Do you find any?
Health worker: No, I do not find any general danger signs in this case.
Case 2: Hassan
Hassan is 3 years old. He weighs 12 kg. His temperature is 39oC.
The health worker asked, 'What are the child's problems?' The mother said, 'Hassan
has been vomiting everything for 2 days.' This is Hassan's initial visit for this problem.
The purpose of this Health Policy Study is to better understand adolescents’ views on what are considered core components of the medical home and identify barriers to promoting adolescent health in relation to the medical home.
In addition, this study sought to better understand the needs and challenges in providing adolescents with access to medical homes—from the perspective of both adolescents and experts in adolescent health and medical home policy. To accomplish these goals, researchers conducted focus groups with adolescents, presented these findings to experts, and gathered experts’ reactions to the adolescents’ perspectives. This report includes a detailed description of the methods used for this study, followed by a summary of key focus group findings and the expert reactions to these findings.
This document provides an analysis of the concept of pediatric palliative care. It begins with background information on the need for concept analysis given that pediatric palliative care is a relatively new field that is not well defined. It then outlines the objectives, assumptions, definitions from literature, model and borderline cases to help clarify and define the concept. The overall goal of the analysis is to enhance understanding of pediatric palliative care among nurses to improve care for children with life-limiting illnesses and their families.
This document provides an introduction and overview of the Integrated Management of Neonatal and Childhood Illness (IMNCI) clinical guidelines. It discusses that IMNCI takes a syndromic approach to case management of common childhood illnesses for children under 5 in developing countries. The document outlines the components and principles of IMNCI, including improvements to health worker skills, the health system, and family/community practices. It also describes the case management process used in IMNCI and the purpose and methods of IMNCI training courses.
The key priorities for implementation from NICE clinical guideline 99 on the diagnosis and management of idiopathic childhood constipation are:
1. Establish a diagnosis of idiopathic constipation by taking a thorough history and conducting a physical exam to exclude underlying causes, and inform families of the diagnosis and treatment plan.
2. Use polyethylene glycol 3350 + electrolytes as the first-line treatment for disimpaction, starting with an escalating oral dose regimen.
3. Continue laxative treatment for several weeks or months after symptoms resolve to prevent relapse, and combine with behavioral interventions and dietary modifications.
4. Offer ongoing support from specialist healthcare providers to children and families living with id
The document provides an overview of Integrated Management of Childhood Illness (IMCI), which is an integrated approach to child health developed by WHO and UNICEF. IMCI focuses on well-being of children under five years old and includes preventive and curative elements implemented by families, communities, and health facilities. The integrated case management process for sick children ages 1 week to 5 years involves assessing and classifying the child's illnesses, identifying specific treatments, providing treatment instructions, counseling the mother, and follow-up care. The goal is to reduce mortality from major childhood illnesses like pneumonia, diarrhea, and malnutrition through improved skills and systems for managing sick children at primary health facilities.
Web only rx16 treat-wed_1115_1_hudson_2badaOPUNITE
The document discusses treatment and outcomes of neonatal abstinence syndrome (NAS). It summarizes a presentation by two doctors on NAS treatment. It then describes a study examining outcomes of a palliative early treatment model for NAS at Greenville Memorial Hospital. The model involved early low-dose methadone treatment for opioid exposed newborns in a low-acuity nursery setting. Results showed lower length of stay, less weight loss and medical complications compared to national averages, with total hospital costs averaging $5,909 per case.
Systematic approach to the seriously ill or injured childMahmoud Khedr
This document provides guidance on systematically assessing and treating critically ill or injured children. It begins by outlining the objectives of utilizing appropriate assessment techniques to rapidly identify treatment priorities. It then describes the Pediatric Assessment Triangle (PAT) framework, which uses appearance, work of breathing, and skin circulation to evaluate a child's condition within seconds. The document emphasizes that any abnormality in the PAT denotes an unstable child requiring intervention. It provides details on evaluating each component of the PAT and categorizing the child's condition to dictate the type and urgency of treatment needed. Finally, it stresses intervening immediately for life-threatening problems by following ABC protocols, activating emergency response, and focusing on stabilization over detailed diagnosis in critically ill children.
1) The document discusses IMCI (Integrated Management of Childhood Illnesses), a global strategy to improve the health of children under 5 and reduce child mortality from major diseases.
2) IMCI aims to improve the skills of health workers in managing common childhood illnesses, strengthen health systems, and encourage better family/community health practices like breastfeeding.
3) Key components of IMCI include assessing, classifying, treating, and counseling for sick children, with illnesses categorized as red (severe), yellow (needs follow-up), or green (mild). General danger signs that require urgent referral are also outlined.
Outpatient Follow Up Of Premature Infants, by Dr. Khaled El-Atawi A/Consultan...mohamed osama hussein
This document discusses guidelines for outpatient follow up of premature infants after discharge from the hospital. It recommends that infants born weighing less than 1500 grams or with certain medical conditions receive follow up care. The optimal follow up includes assessing growth and development, providing primary care, addressing any unresolved medical issues, developing a home care plan, and arranging support services. Follow up appointments should be scheduled with the primary care physician and any specialists involved in the infant's care. During visits, growth, nutrition, neurodevelopment, and general health should be evaluated based on the infant's adjusted age to account for prematurity. Appropriate screening tests can help identify infants at risk for developmental delays.
TEST BANK For Principles of Pediatric Nursing Caring for Children, 8th Editio...rightmanforbloodline
TEST BANK For Principles of Pediatric Nursing Caring for Children, 8th Edition by Kay Cowen; Laura Wisely, Verified Chapters 1 - 31, Complete Newest Version
The document discusses newborn screening for metabolic disorders. It describes Tyler Wayne's story who died from undiagnosed galactosemia. Metabolic disorders can cause damage if not detected early through newborn screening. The document outlines the benefits of newborn screening such as early detection and treatment before symptoms appear. It describes how tandem mass spectrometry can screen for over 50 treatable disorders simultaneously and efficiently.
The document discusses newborn screening for metabolic disorders using tandem mass spectrometry (MS/MS). It begins with the story of Tyler Wayne who died from undiagnosed galactosemia. It then explains that MS/MS allows for early detection of treatable metabolic disorders before symptoms appear, preventing complications. The document outlines the process and benefits of newborn screening as well as the status of screening programs in various countries including the UAE.
The document discusses newborn screening for metabolic disorders. It describes Tyler Wayne's story who died from undiagnosed galactosemia. Metabolic disorders can cause damage if not detected early through newborn screening. The document outlines the benefits of newborn screening such as early detection and treatment before symptoms appear. It describes how tandem mass spectrometry can screen for over 50 treatable disorders simultaneously.
The document discusses human life cycles and survival from birth, focusing on birth asphyxia. It summarizes that birth asphyxia is a major cause of neonatal death and neurological disability. Interventions are needed during the antenatal, intrapartum, and postnatal periods to improve survival and prevent complications of birth asphyxia. These include good antenatal care, skilled birth attendance, emergency obstetric care, newborn resuscitation, and community-based newborn care.
Introduction who integrated management_of_childhood_illness-convertedDrHassanAliIndhoy
The document summarizes the World Health Organization's Integrated Management of Childhood Illness (IMCI) strategy. IMCI integrates the case management of common childhood illnesses, especially the leading causes of death for children under 5. It provides standardized guidelines and tools for healthcare workers to assess, classify, treat and counsel children with multiple conditions. The goal is to improve the quality of care for sick children and reduce mortality rates through an integrated approach to treating the most common illnesses together.
Conferencia de la Dra. Joanne Wolfe sobre Cuidados Paliativos Pediátricos, en...PrincipitoJuanPi
This document summarizes a presentation on pediatric palliative care given by Dr. Joanne Wolfe. It discusses the scope of pediatric palliative care needs, including common diagnoses, symptoms, and technologies used to treat children with life-threatening illnesses. It also describes the suffering experienced by patients and their families from physical, psychological, social, and existential distress. Additionally, it outlines the Boston Pediatric Palliative Care experience, including the interdisciplinary team approach, strategies used, and outcomes demonstrating improved symptom management, family satisfaction, and reduced healthcare utilization. Finally, it discusses adapting the pediatric palliative care model to low and middle income countries by assessing available resources and integration with local care providers.
The document discusses epilepsy and seizures, providing information on:
- What epilepsy is and how it differs from seizures
- Common causes of epilepsy including head trauma, brain tumors, and genetics
- What happens during different types of seizures
- Strategies for responding appropriately to seizures, such as staying calm, protecting the person's head, and calling for medical help if the seizure lasts more than 5 minutes
- Effective strategies for working with students who have epilepsy, including understanding their needs, clear communication with parents and schools, and teaching life skills.
This document provides a case definition and guidelines for collecting, analyzing, and presenting data on neonatal encephalopathy as an adverse event following maternal immunization. It defines neonatal encephalopathy as an abnormal level of alertness or seizures in an infant born at or after 35 weeks gestation, potentially due to hypoxia/ischemia, metabolic disturbance, or infection. The definition aims to improve comparability of vaccine safety data across different healthcare settings and regions. It was developed through consensus of an expert working group using a literature review on neonatal encephalopathy and adverse events following immunization.
IMCI POWER POINT PRESENTATIONS-2-5 YEARS (2).pptkkean6089
Check for general danger signs. Do you find any?
Health worker: No, I do not find any general danger signs in this case.
Case 2: Hassan
Hassan is 3 years old. He weighs 12 kg. His temperature is 39oC.
The health worker asked, 'What are the child's problems?' The mother said, 'Hassan
has been vomiting everything for 2 days.' This is Hassan's initial visit for this problem.
The purpose of this Health Policy Study is to better understand adolescents’ views on what are considered core components of the medical home and identify barriers to promoting adolescent health in relation to the medical home.
In addition, this study sought to better understand the needs and challenges in providing adolescents with access to medical homes—from the perspective of both adolescents and experts in adolescent health and medical home policy. To accomplish these goals, researchers conducted focus groups with adolescents, presented these findings to experts, and gathered experts’ reactions to the adolescents’ perspectives. This report includes a detailed description of the methods used for this study, followed by a summary of key focus group findings and the expert reactions to these findings.
This document provides an analysis of the concept of pediatric palliative care. It begins with background information on the need for concept analysis given that pediatric palliative care is a relatively new field that is not well defined. It then outlines the objectives, assumptions, definitions from literature, model and borderline cases to help clarify and define the concept. The overall goal of the analysis is to enhance understanding of pediatric palliative care among nurses to improve care for children with life-limiting illnesses and their families.
This document provides an introduction and overview of the Integrated Management of Neonatal and Childhood Illness (IMNCI) clinical guidelines. It discusses that IMNCI takes a syndromic approach to case management of common childhood illnesses for children under 5 in developing countries. The document outlines the components and principles of IMNCI, including improvements to health worker skills, the health system, and family/community practices. It also describes the case management process used in IMNCI and the purpose and methods of IMNCI training courses.
The key priorities for implementation from NICE clinical guideline 99 on the diagnosis and management of idiopathic childhood constipation are:
1. Establish a diagnosis of idiopathic constipation by taking a thorough history and conducting a physical exam to exclude underlying causes, and inform families of the diagnosis and treatment plan.
2. Use polyethylene glycol 3350 + electrolytes as the first-line treatment for disimpaction, starting with an escalating oral dose regimen.
3. Continue laxative treatment for several weeks or months after symptoms resolve to prevent relapse, and combine with behavioral interventions and dietary modifications.
4. Offer ongoing support from specialist healthcare providers to children and families living with id
The document provides an overview of Integrated Management of Childhood Illness (IMCI), which is an integrated approach to child health developed by WHO and UNICEF. IMCI focuses on well-being of children under five years old and includes preventive and curative elements implemented by families, communities, and health facilities. The integrated case management process for sick children ages 1 week to 5 years involves assessing and classifying the child's illnesses, identifying specific treatments, providing treatment instructions, counseling the mother, and follow-up care. The goal is to reduce mortality from major childhood illnesses like pneumonia, diarrhea, and malnutrition through improved skills and systems for managing sick children at primary health facilities.
Web only rx16 treat-wed_1115_1_hudson_2badaOPUNITE
The document discusses treatment and outcomes of neonatal abstinence syndrome (NAS). It summarizes a presentation by two doctors on NAS treatment. It then describes a study examining outcomes of a palliative early treatment model for NAS at Greenville Memorial Hospital. The model involved early low-dose methadone treatment for opioid exposed newborns in a low-acuity nursery setting. Results showed lower length of stay, less weight loss and medical complications compared to national averages, with total hospital costs averaging $5,909 per case.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
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This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
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NURSEpedseizure_slide_set.ppt
1. NURSE - Pediatric Seizures
Illinois Emergency Medical Services for Children
March 2012
Illinois EMSC is a collaborative program between the Illinois Department of Public
Health and Loyola University Health System. Development of this presentation
was supported in part by: Grant 5 H34 MC 00096 from the Department of Health
and Human Services Administration, Maternal and Child Health Bureau
2. Illinois Emergency Medical
Services for Children (EMSC)
Illinois EMSC is a collaborative program between the Illinois
Department of Public Health and Loyola University Health
System, aimed at improving pediatric emergency care within our
state.
Since 1994, The Illinois EMSC Advisory Board and several
committees, organizations and individuals within EMS and
pediatric communities have worked to enhance and integrate:
Pediatric education
Practice standards
Injury prevention
Data initiatives
2
3. Illinois EMSC
The goal of Illinois EMSC is to ensure that
appropriate emergency medical care is
available for ill and injured children at every
point along the continuum of care.
3
This educational activity is being presented
without bias or conflict of interest from the
planners and presenters.
4. Susan Fuchs MD, FAAP, FACEP
Chair, EMSC Quality Improvement Subcommittee
Children’s Memorial Hospital
Carolynn Zonia, DO, FACOEP, FACEP
Chair, EMSC Facility Recognition Committee
Loyola University Health System
Illinois EMSC Quality Improvement Subcommittee & EMSC Facility Recognition Committee
Paula Atteberry, RN, BSN
Illinois Department of Public Health
Joseph R. Hageman, MD, FAAP
NorthShore University Health
System - Evanston
Cheryl Lovejoy, RN, TNS
Advocate Condell Medical Center
S. Margaret Palk, MD, FAAP
University of Chicago
Comer Children’s Hospital
Herbert Sutherland, DO, FACEP
Central DuPage Hospital
Maureen Bennett, RN, BSN
Loyola University Health System
Sandy Hancock, RN, MS
Saint Alexius Medical Center
Evelyn Lyons, RN, MPH
Illinois Department of Public Health
Parul Patel, MD, MPH, FAAP
Children’s Memorial Hospital
John Underwood, DO, FACEP
Swedish American Hospital
Mark Cichon, DO, FACOEP,
FACEP
Loyola University Health System
Melodie Havlick, RN, BSN, CEN
Rush Copley Memorial Hospital
Patrician Metzler, RN, TNS, SANE-A
Carle Foundation Hospital
Anita Pelka, RN
University of Chicago
Comer Children’s Hospital
LuAnn Vis, RN, MSOD, CPHQ
Loyola University Health System
Kristine Cieslak, MD, FAAP
Children’s Memorial at Central
DuPage Hospital
Kathryn Janies, BA
Illinois EMSC
Michele Moran, RN
Central DuPage Hospital
Anne Porter, PhD, RN, CPHQ
Healthcare Consultant
Jim Wells, RN
Blessing Hospital
Jacqueline Corboy, MD, FAAP
Children’s Memorial Hospital
Cindi LaPorte, RN
Loyola University Health System
Beth Nachtsheim Bolick, RN, MS,
DNP, CPNP-AC, PNP-BC
Rush University
Laura Prestidge, RN, BSN
Illinois EMSC
Leslie Wilkans, RN, BSN
Advocate Good Shepherd Hospital
Don Davidson, MD
Carle Foundation Hospital
Sue Laughlin, RN
Community Memorial Hospital
Andrea Nofsinger, RN, BSN, SANE-A
OSF St. Francis Medical Center
Vanessa Scheidt, RN
Franciscan St. James Health
Beverly Weaver, RN, MS
Northwestern Lake Forest Hospital
Leslie Foster, RN, BSN
OSF St. Anthony Medical Center
Daniel Leonard, MS, MCP
Illinois EMSC
Charles Nozicka, DO, FAAP, FAAEM
Advocate Condell Medical Center
J. Thomas Senko, DO, FAAP
John H. Stroger Jr. Hospital of
Cook County
Special Thanks to:
Jorge Asconapé, MD
Loyola University Health System
Ryan Gagnon, RN
Advocate Christ Medical Center
Jammi Likes, RN, BSN,
NREMT-P
Herrin Hospital
Linnea O’Neill, RN, MPH
Metropolitan Chicago Healthcare
Council
Cathleen Shanahan, RN, BSN, MS
Children’s Memorial Hospital
Eugene Schnitzler, MD
Loyola University Health System
Editors: Christine Kennelly, RN, MS; Sharon M. McCarthy, RN, MS, CPNP
Acknowledgements
4
5. Purpose
The purpose of this educational module is to
enhance the care of pediatric patients who
present with seizures through appropriate
Assessment
Management
Prevention of complications, and
Disposition (including patient &
parent/caregiver education)
Suggested Citation: Illinois Emergency Medical Services for Children
(EMSC), NURSE-Pediatric Seizures, March 2012
5
6. Exclusions
Management of post traumatic seizures
is beyond the scope of this module and
will not be addressed.
Neonatal seizures are not addressed in
the body of this module. However,
information can be found in Appendix C.
6
7. Pediatric Seizures
Few health care problems elicit more distress
than witnessing a child having a seizure. It is
terrifying to many. When the victim is a child,
and the observer is a parent or caregiver, that
terror can become panic.
This module seeks to aid you in minimizing
that distress and maximizing the outcome for
your patient with evidence-based guidelines.
7
8. Objectives
At the conclusion of this module, you will be
able to:
Manage the child with a seizure in the prehospital and
Emergency Department (ED) settings
Identify the distinguishing characteristics between
types of seizures in the pediatric patient
Explain the rationale for specific diagnostic testing
Provide educational information related to
care of a child with seizures
NOTE: Hyperlinks are provided throughout the module to offer additional information 8
9. Table of Contents
1. Introduction and Background
2. Febrile Seizure
3. First Unprovoked Seizure
4. Status Epilepticus
5. References
6. Resources
7. Appendices
APPENDIX A – EMSC Prehospital Protocols
APPENDIX B – Sample Emergency Department Guidelines
APPENDIX C – Neonatal Seizures
9
11. 300,000 people have a first seizure
each year
120,000 are under 18 years of age
Between 75,000 and 100,000 are under 5
years of age who have experienced a
febrile seizure
326,000 school aged children through
15 years of age have epilepsy
U.S. Demographics1
11
12. Incidence in Illinois
In 2009, 14,400 children aged 0-18 years
were seen in the Emergency Department
as a result of seizures
Nearly 6,500 required
hospitalization
12
(Source: Illinois Hospital Association. COMPdata. Hospital Discharge database)
13. Illinois EMSC Statewide
Pediatric Seizure QI Project
In 2010 - 2011, Illinois EMSC conducted a statewide
survey of Emergency Department practice patterns
(including medical record reviews) related to children
presenting with:
Simple Febrile Seizure (SFS)
Unprovoked Seizures (UnS), and
Status Epilepticus (SE)
13
(Source: Illinois EMSC Pediatric Seizures in the Emergency Department Summary Report May 2011)
14. Pediatric Seizure QI Project (cont.)
Opportunities for improvement:
Less than half of responding facilities had a
protocol/policy/guideline/clinical pathway that addressed the
clinical management of seizures overall (44%) or clinical
management SE in particular (19%)
In the prehospital management of pediatric seizures, blood
glucose assessments were documented in only 34% of SFS
patients and slightly over half of UnS/SE patients
For UnS/SE patients, seizure precautions were either not
taken or not documented in more than 1/3rd of the cases
(Source: Illinois EMSC Pediatric Seizures in the Emergency Department Summary Report May 2011)
14
15. A Seizure Is:
15
Abnormal neuronal activity
A sudden biochemical imbalance at the cell
membrane
Repeated abnormal electrical discharges
Seen clinically as changes in motor control,
sensory perception and/or autonomic
function2
16. Clinical Presentation
Motor Changes
Parents/caregivers may report seeing:
Repetitive non-purposeful movements
Staring
Lip-smacking
Falling down without cause
Stiffening of any or all extremities
Rhythmic shaking of any or all extremities
16
Seizure activity cannot be interrupted with verbal
or physical stimulation3
17. Clinical Presentation
Sensory and Autonomic
Parents/caregivers may report the child is:
Feeling nauseous
Feeling odd or peculiar
Losing control of bowel or bladder
Feeling numbness, tingling
Experiencing odd smells or sounds
17
18. Clinical Presentation
Consciousness
Consciousness is the usual alertness or
responsiveness the child demonstrates.
Parents/caregivers may report or you may
observe the child to have:
Baseline alertness
Diminished level of consciousness
Unresponsive and unconscious
18
20. Seizure Classifications
Generalized Partial
Complex Simple
Involves BOTH hemispheres
of the brain
May have aura No impaired consciousness
Always involves loss of
consciousness
Involves motor* or
autonomic# symptoms
with altered level of
consciousness
Can involve motor,* autonomic#
or somatosensory+ symptoms
Types:
Tonic or clonic movements
or combination (grand mal)
Absence (petit mal)
Myoclonic
Atonic (e.g., drop attacks)
Infantile spasms
May generalize May generalize
Types of symptoms:
1) Motor* - head/eye deviation, jerking, stiffening
2) Autonomic# - pupils dilatation, drooling, pallor, change in heart rate or
respiratory rate
3) Somatosensory+ - smells, alteration of perception (déjà vu)
20
21. Generalized Seizure Classification:
Descriptions1
Absence - Abrupt lapses of consciousness
lasting a few seconds
Atonic - Abrupt, unexpected loss of muscle
tone
Myoclonic - Rapid short contractions of one
or all extremities
21
23. Febrile Seizure4
Febrile seizures are the most common
seizure disorder in childhood, affecting
2 - 5% of children between the ages of
6 months and 5 years
23
24. Febrile Seizure5
Caused by the increase in the core body
temperature greater than 100.4F or 38C
Threshold of temperature which may trigger
seizures is unique to each individual
Can occur within the first 24 hours of an
illness
Can be the first sign of illness in 25 - 50% of
patients
24
25. Febrile Seizure: Characteristics
Are benign
Occurrence: between 6 months to 5 years of
age
May be either simple or complex type seizure
Seizure accompanied by fever (before, during
or after) WITHOUT ANY
Central nervous system infection
Metabolic disturbance
History of previous seizure disorder
25
26. Febrile Seizure: Two Types4
Simple Febrile
6 months – 5 years of age
Febrile before, during or after
seizure
Generalized seizure
lasting less than 15
minutes, and
Occurs once in a 24-hour
period
Complex Febrile
6 months – 5 years of age
Febrile before, during or after
seizure
Prolonged (lasting more
than 15 minutes),
Focal seizure, or
Occurs more than once in
24 hours
26
27. Febrile Seizure:
Prehospital Assessment
Assess A,B,C’s
Assess neurological status (D = Disability using AVPU)
Obtain seizure history from a dependable witness:
How long was the seizure?
What did it look like (movements, eye deviation)?
History of previous seizures (child and family)?
Does the child have a current illness/fever?
Any indications of trauma or abuse?
Length of postictal phase?
List current medications
Include any antipyretics given (time and dose)
27
28. AVPU
The AVPU scale (Alert, Voice, Pain, Unresponsive) is a system by which
a healthcare professional can measure and record a child’s level of
consciousness. The AVPU scale should be assessed using these identifiable
traits, looking for the best response of each
A Alert – the infant is active, responsive to parents and interacts
appropriately with surroundings; the child is lucid and fully responsive, can
answer questions and see what you're doing.
V Voice – the child or infant is not looking around; responds to your
voice, but may be drowsy, keeps eyes closed and may not speak
coherently, or make sounds.
P Pain – the child or infant is not alert and does not respond to your
voice. Responds to a painful stimulus, e.g., shaking the shoulders or
possibly applying nail bed pressure.
U Unresponsive – the child or infant is unresponsive to any of the
above; unconscious.
28
29. Febrile Seizure:
Prehospital Management
Monitor A, B, C, D’s
Position with C-Spine protection (if trauma)
Follow seizure and aspiration precautions (per
protocol)
Physical exam
Check blood glucose
If blood glucose < 60, treat as appropriate
Refer to EMSC Seizure protocols (Appendix A) 29
30. Febrile Seizure:
ED Assessment
Baseline assessment
Vital signs (including temperature)
Assess A, B, C, D’s
Continue providing and documenting seizure and
aspiration precautions
30
31. Febrile Seizure:
ED Assessment (cont.)
Full History
Obtain seizure history from a dependable witness:
When did the seizure occur?
How long was the seizure and what did it look like?
How was the child acting immediately before the seizure?
History of previous seizures (child and family)?
History of developmental delay/recent loss of milestones?
Does the child have a current illness/fever?
Any indications of trauma or abuse?
Length of postictal state?
Immunization history?
List current medications
Include any antipyretics given (time and dose)
31
32. Febrile Seizure:
ED Management7
If still seizing, follow Status Epilepticus protocol
Complete physical exam – to identify the source of
fever
If child has a prolonged postictal period - consider
administering glucose
Lab testing - direct toward identifying the source of
fever
For Simple Febrile Seizures: NO ROUTINE LAB TESTS ARE
NECESSARY
32
33. Simple Febrile Seizure:
Lumbar Puncture
Evidence-based recommendations from the 2011 AAP
Subcommittee on Febrile Seizures6 are as follows:
“A lumbar puncture should be performed in any child who presents
with a (simple febrile) seizure and a fever and has meningeal signs
and symptoms (e.g., neck stiffness, Kernig and/or Brudzinski
signs) or in any child whose history or examination suggests the
presence of meningitis or intracranial infection.”
Current data does not support routine lumbar
puncture in well-appearing, fully immunized children
who present with a simple febrile seizure.
33
34. Simple Febrile Seizure:
Lumbar Puncture (cont.)
Additional evidence-based recommendations from the 2011 AAP
Subcommittee on Febrile Seizures6 are as follows:
“In any infant between 6 and 12 months of age who presents with a
(simple febrile) seizure and fever, a lumbar puncture is an option when:
- the child is considered deficient in Haemophilus influenza type b or
Streptococcus pneumoniae immunizations (i.e., has not received
scheduled immunizations as recommended) or
- when the immunization status cannot be determined because of an
increased risk of bacterial meningitis.”
“A lumbar puncture is an option in the child who presents with a (simple
febrile) seizure and fever and is pretreated with antibiotics, because
antibiotic treatment can mask the signs and symptoms of meningitis.”
34
35. Simple Febrile Seizure:
Diagnostic Testing4,6
EEG CT/MRI
Simple
Febrile
Seizure
Should not be performed
in a neurologically
healthy child.
Results are not predictive of
recurrence or development
of epilepsy
Not indicated
35
There are no current national guidelines addressing
diagnostic testing recommendations for complex
febrile seizures.
36. Simple Febrile Seizure:
ED Ongoing Management
Reassess temperature
Consider giving antipyretic if not
previously administered
As source of fever is identified, treat
appropriately
36
37. Simple Febrile Seizure:
Family Education4,6
Here are some frequently asked questions parents/
caregivers may have prior to discharge:
Is my child brain damaged?
There is no evidence of impact on learning abilities after
seizure from SFS.
Will this happen again?
If child is under 12 months of age at time of first seizure,
recurrence rate is 50%
If child is greater than 12 months of age at time of first seizure,
recurrence rate is 30%
Most recurrences occur within 6-12 months of the initial febrile
seizure
37
38. Simple Febrile Seizure:
Family Education4,6 (cont.)
Will my child get epilepsy?
For simple febrile seizures, there is no increased risk
of epilepsy
Why not treat for possible seizures or fever?
Anticonvulsants can reduce recurrence. However
potential side effects of medications outweigh the
minor risk of recurrence
Prophylactic use of antipyretics does not have impact
on recurrence
38
For complex febrile seizures, there is a
slight increase in the risk of epilepsy.
39. Simple Febrile Seizure:
Family Education7 (cont.)
Instruct parent/caregivers to prevent injury during a
seizure :
Position child while seizing in a side-lying
position
Protect head from injury
Loosen tight clothing about the neck
Prevent injury from falls
Reassure child during event
Do not place anything in the child’s mouth
39
40. Simple Febrile Seizure:
Disposition
Prior to discharge home…
Educate regarding use of:
Thermometer
Antipyretics for fever management
When to contact 9-1-1 or ambulance
Identify Primary Care Provider for follow-up
appointment and stress importance of follow-up
Provide developmentally appropriate explanation of
event for child and family members
40
41. Febrile Seizure:
Test Yourself
1. Simple Febrile Seizures:
A. Indicate an underlying neurological condition
B. Require anticonvulsant medication
C. Occur in children 6 months to 5 years of age
D. Frequently lead to epilepsy
2. Which of the following are
important history questions?
A. Was there trauma ?
B. What did the seizure look like?
C. Medications and herbal supplements?
D. All of the above
3. Diagnostic workup in the ED
is based on suspicions of:
A. Meningitis
B. Trauma
C. Unknown immunization status
D. All of the above
4. Discharge education should
include which of the
following?
A. Teaching about EEG results
B. Importance of antipyretics for fever
C. Importance of follow up MRI
D. Teaching about anticonvulsant
medications
Proceed to next slide for answers
41
42. Febrile Seizure:
Test Yourself: ANSWER KEY
1. Simple Febrile Seizures:
C. Occur in children 6 months to 5 years of age
2. Which of the following are
important history questions?
D. All of the above
3. Diagnostic workup in the ED
is based on suspicions of:
D. All of the above
4. Discharge education should
include which of the
following?
B. Importance of antipyretics for fever
42
44. First Unprovoked Seizure8
This is a first seizure that occurs without an immediate
precipitating event. Etiology may be:
Remote symptomatic (related to a pre-existing brain
abnormality/insult)
Cryptogenic or idiopathic (no known cause)
Predictors of recurrence include: abnormal EEG,
underlying etiology, and abnormal neurologic exams
Remote symptomatic – recurrence risk over 2 yrs is above 50%
Cryptogenic or idiopathic – recurrence risk over 2 yrs is
30-50%
If first seizure is prolonged, recurrent seizures are more likely to
be prolonged.
44
45. First Unprovoked Seizure:
Presentation
Parents/caregivers may describe symptoms
consistent with the following:
Partial seizure
Generalized onset, tonic-clonic seizure
Tonic seizure
45
Remember: this is a seizure that occurs
without an immediate precipitating event.
46. First Unprovoked Seizure:
Prehospital Assessment
Assess A, B, C, D’s
Obtain seizure history from a dependable witness:
How long was the seizure?
What did it look like (movements, eye deviation)?
History of previous seizures (child and family)?
Does the child have a current illness/fever?
Any indications of trauma or abuse?
Length of postictal state
List current medications
Include any antipyretics given (time and dose)
46
47. First Unprovoked Seizure:
Prehospital Management
Monitor A, B, C, D’s
Position with C-Spine protection (if trauma)
Follow seizure and aspiration precautions (per protocol)
Physical assessment
Check blood glucose
If blood glucose < 60, treat as appropriate
Refer to EMSC Seizure protocols (Appendix A)
47
48. First Unprovoked Seizure:
ED Assessment
Baseline assessment
Vital signs (including temperature)
Assess A, B, C, D’s
Continue providing and documenting seizure and
aspiration precautions
48
49. First Unprovoked Seizure:
ED Assessment (cont.)
If still seizing, follow Status Epilepticus protocol
Full History
Obtain seizure history from a dependable witness:
Recent exposures (chemical, industrial)?
When did the seizure occur?
How long was the seizure and what did it look like?
How was the child acting immediately before the seizure?
History of previous seizures (child and family)?
History of developmental delay/recent loss of milestones?
Does the child have a current illness?
Any indications of trauma or abuse?
Length of postictal state?
49
50. First Unprovoked Seizure:
ED Assessment (cont.)
List current medications
Include any antipyretics given (time and dose)
Include anticonvulsants given by prehospital
team (time and dose)
Physical exam
Head-to-toe assessment
50
51. First Unprovoked Seizure:
Diagnostic Testing8
Laboratory tests are based on individual
clinical circumstances and may include:
CBC with differential
Blood glucose
Electrolytes
Calcium, magnesium, phosphorous
Urine drug/toxicology screen
Urine HCG (age dependent)
51
Lumbar puncture is only indicated if there are other
symptoms that suggest a diagnosis of meningitis.
52. First Unprovoked Seizure:
Diagnostic Testing – MRI8,9
Outpatient MRI should be considered for:
Children under 1 year of age
All children with significant acute cognitive or motor
impairment
Unexplained abnormalities on neurologic exam
Seizure of focal onset without generalization
Abnormal EEG
Abnormalities on MRI are seen in up to 1/3rd of
children
However, most abnormalities do not influence immediate
treatment or management (such as need for hospitalization)
52
53. First Unprovoked Seizure:
Diagnostic Testing - CT Scan8,9
Emergent CT Scan (without contrast) should be
considered for any child who exhibits any of the
following:
Significant, acute cognitive or motor
impairment
New focal deficit not quickly resolving
Not returned to baseline
53
MRI is the modality of choice, if available.
54. First Unprovoked Seizure:
Diagnostic Testing – EEG8,9
Obtain on ALL children in whom a nonfebrile
seizure has been diagnosed
Can be arranged as an outpatient
Should be interpreted by a neurologist
(preferably pediatric neurologist)
EEG results will:
Help predict the risk of recurrence
Classify the seizure type or epilepsy
syndrome
Influence the decision to perform additional
neuroimaging studies
54
55. First Unprovoked Seizure:
ED Management
If child is still actively seizing…
Refer to Status Epilepticus protocol
When child is stable…
Consult with Neurologist (or Intensivist)
For possible medication recommendations
To determine disposition:
Admit to observe
Transfer (if neurologist is unavailable)
Discharge home
55
56. First Unprovoked Seizure:
Drug Therapy8,9
The majority of children who experience an
unprovoked seizure will have few or no
recurrences
Approximately 10% will go on to have additional
seizures regardless of therapy
Type of medication if offered depends on:
Type, frequency and severity of seizures
Side effects, titration, drug interactions, dosing
forms, cost of drug
Neurologist preference
56
57. First Unprovoked Seizure:
Discharge & Family Education
Prior to discharge home…
Identify Primary Care Provider and Neurologist for
follow-up appointments
Provide plan for outpatient EEG
Provide parental support
Consider rescue medication for home, based on
neurologist recommendation (e.g., rectal
diazepam)
57
58. First Unprovoked Seizure:
Family Education7
Instruct parent/caregivers to prevent injury
during a seizure:
Position child while seizing in a side-lying
position
Protect head from injury
Loosen tight clothing about the neck
Prevent injury from falls
Reassure child during event
Do not place anything in the child’s mouth
58
59. First Unprovoked Seizure:
Family Education (cont.)
Instruct in use of 9-1-1 or ambulance services
Provide developmentally appropriate explanation
to child about the seizure event and treatment
Discourage swimming alone
No driving a car until cleared by a physician
59
60. First Unprovoked Seizure:
Family Education (cont.)
Here are some frequently asked questions
parents may have prior to discharge:
How likely is it that my child will have seizures again?
The risk of recurrence relates to the underlying etiology and EEG
results (normal or abnormal). The majority of children who experience
an unprovoked seizure will have few or no recurrences. Approximately
10% will go on to have additional seizures regardless of therapy.8
Is there a risk of dying from the seizure if we don’t start
medication today?
Sudden unexpected death is very uncommon (usually related to an
underlying neurologic handicap rather than seizure activity).
There are no studies showing treatment after a first seizure alters the
small risk of sudden death.8
60
61. First Unprovoked Seizure:
Test Yourself
1. Which of the following is a true statement regarding a First Unprovoked Seizure:
A. Occurs without a precipitating event
B. Is never associated with an underlying neurological condition
C. Always leads to epilepsy
D. Requires immediate initiation of antiepileptic medication
2. Children who have a First Unprovoked Seizure…
A. Have their blood glucose checked by ambulance staff
B. Could proceed to have Status Epilepticus
C. Will require anti-pyretics to prevent seizures
D. A and B
3. All children who have had a First Unprovoked Seizure should have an outpatient EEG.
TRUE FALSE
4. The majority of children who have a First Unprovoked Seizure will have few or no
recurrences.
TRUE FALSE
Proceed to next slide for answers
61
62. First Unprovoked Seizure:
Test Yourself: ANSWER KEY
1. Which of the following is a true statement regarding a First Unprovoked Seizure:
A. Occurs without a precipitating event
2. Children who have a First Unprovoked Seizure…
D. A and B
3. All children who have had a First Unprovoked Seizure should have an outpatient EEG.
TRUE
4. The majority of children who have a First Unprovoked Seizure will have few or no
recurrences.
TRUE
62
64. Status Epilepticus:
Definitions10
Seizures that persist without interruption for
more than 5 minutes
Two or more sequential seizures without full
recovery of consciousness between seizures
This is a life threatening emergency that
requires immediate treatment.
64
65. Status Epilepticus10
Commonly occurs in children with epilepsy (9 -27%
over time)
Complications from Status Epilepticus result from both
the impact of the convulsive state on the body systems
(such as the cardiac and respiratory systems) and the
neuronal cellular injury which leads to cell death
Rapid termination of the seizure activity protects
against neuronal injury
65
66. Status Epilepticus:
Types, Incidence and Description11
66
Type Incidence Description
Remote Symptomatic SE 33%
Status Epilepticus (SE) with no
immediate event but the child had a
previous history of CNS malformation,
traumatic brain injury or chromosomal
disorder
Acute Symptomatic SE 26%
SE with concurrent acute illness (e.g.,
meningitis, encephalitis, hypoxia,
trauma, intoxication)
Febrile SE 22%
SE with a febrile illness but not a
Central Nervous System infection (e.g.,
sinusitis, sepsis, upper respiratory
infection)
Cryptogenic SE 15% SE with no identifiable cause
67. Status Epilepticus:
Prehospital Assessment
Assess A, B, C, D‘s
Obtain seizure history from a dependable
witness:
When did the seizure begin?
What did it look like (movements, eye deviation)?
History of previous seizures (child and family)?
Does the child have a current illness/fever?
Any indications of trauma or abuse?
Emergency Information Form for Children with
Special Needs?
67
68. Status Epilepticus:
Prehospital Assessment
List current medications
Include any antipyretics given (time and dose)
Do the parents have any anticonvulsant
medications (e.g., rectal diazepam)?
Have parents given any anticonvulsant
medications (time and dose)?
68
69. Assess A, B, C, D’s
Positioning (with C-Spine protection if trauma)
Jaw thrust
Recovery position (side-lying)
Provide nasal airway, if needed
Seizure safety precautions (per protocol)
Aspiration precautions (per protocol)
Oxygen
Suction
Blood glucose testing
If blood glucose < 60, treat as appropriate
69
Status Epilepticus:
Prehospital Assessment
70. If parent/caregiver has rectal diazepam and
has not given it, the parent/caregiver should
be requested to administer it
Document time and dose
Follow Pediatric Seizures ALS guideline
(if appropriate)
Contact Medical Control
REFER TO APPENDIX A for EMSC Seizure Protocols
70
Status Epilepticus:
Prehospital Assessment
71. Status Epilepticus:
ED Goals of Therapy10,12
Minimize seizure time as much as possible
and provide drug therapy promptly.
Drug therapy to halt seizure
With IV/IO access, *LORazepam IV/IO
If no IV/IO access, start with Diazepam PR
*The Institute for Safe Medication Practices recommends using
Tall Man (mixed case) letters in order to distinguish drugs with
similar sounding names – decreasing the chances of safety errors.
71
72. Status Epilepticus:
ED Assessment
Assess A, B, C, D’s
Full vital signs; check bedside glucose and treat
(per protocol)
Continue to provide and document seizure and
aspiration precautions (per protocol)
Review Prehospital History and Treatment
72
73. Status Epilepticus:
ED Management
Full History
Obtain seizure history from a dependable witness:
How long has the seizure been going on and what did it
look like when it started?
How was the child acting immediately before the
seizure?
History of previous seizures (child and family)?
History of developmental delay/recent loss of
milestones?
Does the child have a current illness?
Any indications of trauma or abuse?
Immunization status
73
74. Status Epilepticus:
ED Assessment
Assess E (exposure)
Current medications?
When were they last given?
Recent exposures - chemical, industrial, infectious?
Was patient recently out of the country?
74
75. Status Epilepticus:
ED Management – First 5 Minutes12
Evaluate airway
Suction, position and provide nasal airway as needed
Provide 100% oxygen (non-rebreather)
Establish vascular access
Draw labs as determined by history (examples:)
CBC, Electrolytes, Blood glucose, Calcium, Magnesium, Phosphorus
Toxicology screen, if indicated by history
Antiepileptic drug level, as indicated
Administer benzodiazepines
LORazepam IV/IO 0.1 mg/kg
No IV access, give either:
Diazepam PR 0.5 mg/kg (max PR dose = 20 mg) or
Midazolam IM 0.1 - 0.2 mg/kg
Benzodiazepines may
cause respiratory
and cardiac depression.
REFER TO APPENDIX B for sample guidelines 75
76. Reassess A, B, C’s
Continue supportive airway management
Suction, position and provide nasal airway as needed
Provide 100% oxygen (non-rebreather)
Evaluate results of rapid blood glucose testing
If the seizure activity continues…
Administer medications (per guidelines)
Repeat IV LORazepam 0.1 mg/kg
Administer IV/IM Fosphenytoin 20 mg/kg PE (Phenytoin
equivalents)
REFER TO APPENDIX B for sample guidelines 76
PHENobarbital
is preferred in
neonates.
Status Epilepticus:
ED Management – Next 10 Minutes12
77. Having administered 2-3 doses of benzo-
diazepines, and a dose of Fosphenytoin
without halting the seizure, consider the
patient in refractory Status Epilepticus13
Consult with Neurology and/or Intensivist for
further management recommendations
If available, evaluate lab results
77
REFER TO APPENDIX B for sample guidelines
Status Epilepticus:
ED Management – Next 15 Minutes12
78. If seizure activity persists (after appropriate doses of
benzodiazepines and Fosphenytoin), load with a
second long-acting AED that was not used initially
(e.g., phenobarbital, valproic acid)
Consider loading with Midazolam IV 0.1 - 0.2 mg/kg
Manage with continuous EEG monitoring
Contact PICU/NICU to begin transfer to higher level of care
78
REFER TO APPENDIX B for sample guidelines
It is imperative to stop the seizure activity.
If rapid sequence induction is necessary, use short-acting
paralytics to ensure that ongoing seizure activity is not masked.
Status Epilepticus:
ED Management – Refractory SE
79. For a child in Status Epilepticus after 30
minutes of refractory SE, enact plans to
transfer to your PICU/NICU or transport to a
higher level of care
Continued testing can be arranged in that
setting
Consider EEG with new onset SE
Neuroimaging (CT/MRI) if etiology is unknown
REFER TO APPENDIX B for sample guidelines 79
Status Epilepticus:
ED Management – Transfer13
80. Status Epilepticus:
Disposition
Discuss child’s progress and advice
regarding admission or transfer based on
patient status and neurology consultation with
parents/caregiver
Utilize a specialty/critical care transport team
(If applicable) Explain these events to child in
developmentally appropriate manner
80
81. Status Epilepticus:
Parent Education
Provide parents/caregivers information
regarding child’s condition and treatment
plan
Provide emotional/psychosocial support
Encourage use of the ACEP/AAP Emergency
Information Form for possible future events
81
82. Status Epilepticus:
Emergency Information Form
The Emergency Information Form (EIF) for Children With Special
Needs resource was developed by the American College of Emergency
Physicians (ACEP) and the American Academy of Pediatrics (AAP).
As a standardized medical summary it has
Information for prehospital and
hospital emergency care personnel
Updates entered by caregivers
English and Spanish versions
24-hour accessibility
Free, Downloadable, interactive forms are
available at the ACEP and the AAP websites.
82
To be completed by both the child’s medical team and parents/caregivers.
Copies should be kept by parents, as well as on file at the PCP’s office,
subspecialist’s office, local ED, and school nurse’s office.
83. Status Epilepticus:
Test Yourself
1. You respond to a 9-1-1 call for a 4-year-old child. You find the child on
the floor of the playroom, unresponsive to voice with rhythmic movements
of both the upper and lower extremities. The parents report that the child
has had seizures, starting at age 2. The seizure activity has always lasted
only about 1 minute. The parents called 9-1-1 when the initial seizure
stopped, but the seizure started again with about one minute in between.
They estimate the child has been seizing for about 15 minutes.
Your FIRST response is to:
A. Move the child to the bed
B. Establish vascular access
C. Protect/position the airway
D. Give rectal diazepam
Proceed to next slide for answer
83
84. Status Epilepticus:
Test Yourself: ANSWER KEY
1. You respond to a 9-1-1 call for a 4-year-old child. You find the child on
the floor of the playroom, unresponsive to voice with rhythmic movements
of both the upper and lower extremities. The parents report that the child
has had seizures, starting at age 2. The seizure activity has always lasted
only about 1 minute. The parents called 9-1-1 when the initial seizure
stopped, but the seizure started again with about one minute in between.
They estimate the child has been seizing for about 15 minutes.
Your FIRST response is to:
C.Protect/position the airway
Proceed to next slide
84
85. Status Epilepticus:
Test Yourself
2. How quickly should the first benzodiazepine be given after status epilepticus
begins?
A. At 30 minutes
B. At 20 minutes
C. Within 5 minutes
D. After 60 minutes
3. What drugs are used first in status epilepticus?
A. Lorazepam
B. Fosphenytoin
C. Diazepam
D. A and C
4. Who is likely to have status epilepticus?
A. Child with a history of epilepsy
B. Child with encephalitis
C. Child with a traumatic brain injury
D. All of the above Proceed to next slide for answers 85
86. Status Epilepticus:
Test Yourself: ANSWER KEY
2. How quickly should the first benzodiazepine be given after status epilepticus
begins?
C. Within 5 minutes
3. What drugs are used first in status epilepticus?
D. A and C
4. Who is likely to have status epilepticus?
D. All of the above
86
88. References
1. Epilepsy and Seizure Statistics. (2010). EpilepsyFoundation.org. Retrieved April
21, 2011 from http://www.epilepsyfoundation.org/about/statistics.cfm.
2. Pillow MT, Howes DS, Doctor, SU. Seizures. eMedicine.medscape.com.
Updated Jan 22, 2010.
3. Fisher, PG. First and second seizure: what to do and know. Contemporary
Pediatrics. 2007;24(4):80-89.
4. Steering Committee on Quality Improvement and Management, Subcommittee
on Febrile Seizures. Febrile seizures: clinical practice guideline for the long-term
management of the child with simple febrile seizures. Pediatrics.
2008;121:1281-1286.
5. Freedman SB, Powell EC. Pediatric seizures and their management in the
emergency department. Clin Ped Emerg Med. 2003;4:195-206.
88
89. References (cont.)
6. Steering Committee on Quality Improvement and Management, Subcommittee
on Febrile Seizures. Neurodiagnostic evaluation of the child with a simple febrile
seizure. Pediatrics. 2011;127;389-394.
7. American Association of Neuroscience Nurses. Care of the patient with
seizures. 2nd ed. Glenview (IL): American Association of Neuroscience Nurses;
(Revised 2009). 23 p.
8. Hirtz D, Berg A, Bettis D, et al. Practice parameter: treatment of the child with a
first unprovoked seizure: report of the Quality Standards Subcommittee of the
American Academy of Neurology and the Practice Committee of the Child
Neurology Society. Neurology. 2003;60:166-175.
9. Hirtz D, Ashwal S, Berg A, et al. Practice parameter: evaluating a first nonfebrile
seizure in children: report of the Quality Standards Subcommittee of the
American Academy of Neurology, the Child Neurology Society, and the
American Epilepsy Society. Neurology. 2000;55:616–623.
89
90. References (cont.)
10. Millikan D, Rice B, Silbergleit R. Emergency treatment of status epilepticus:
current thinking. Emerg Med Clin North Am. 2009;27(1):101-113.
11. Riviello JJ Jr., Ashwal S, Hirtz D, et al. American Academy of Neurology
Subcommittee, Practice Committee of the Child Neurology Society. Practice
parameter: diagnostic assessment of the child with status epilepticus (an
evidence-based review): report of the Quality Standards Subcommittee of the
American Academy of Neurology and the Practice Committee of the Child
Neurology Society. Neurology. 2006;67(9):1542-50.
12. Goldstein J. Status epilepticus in the pediatric emergency department. Clin Ped
Emerg Med. 2008;9:96-100.
13. Abend NS, Dlugos DJ. Treatment of refractory status epilepticus: literature
review and a proposed protocol. Pediatr Neurol. 2008;38:377-390.
90
91. Online Resources
American Epilepsy Society
http://www.acep.org/content.aspx?id=26276
American Academy of Neurology Patient Education Materials
http://www.aan.com/go/practice/patient
CDC: Epilepsy
http://www.cdc.gov/Epilepsy/
Citizens United for Research in Epilepsy (CURE)
http://www.cureepilepsy.org/resources/
Epilepsy Foundation: Epilepsy and Seizure Response for Law Enforcement and EMS
(free online training)
http://www.epilepsyfoundation.org/livingwithepilepsy/firstresponders/index.cfm
Epilepsy Therapy Project
http://www.epilepsy.com/epilepsy_therapy_project
91
Return to Table of Contents
92. Video Resources
Understanding Epilepsy
www.youtube.com/watch?v=MNQlq004FkE
Types of Seizures
www.youtube.com/watch?v=CDccChHrgRA&feature=channel
Understanding Partial Seizures
www.youtube.com/watch?v=e10FSjHvV74&feature=channel
Understanding Generalized Seizures
www.youtube.com/watch?v=w5Jv0SZRwwk&feature=channel
What causes Epilepsy
www.youtube.com/watch?v=6NcqQkKjqTI&feature=fvw
Diagnosing Epilepsy
www.youtube.com/watch?v=HX7L11rhRTw&feature=channel
Seizure Imitators Overview
www.youtube.com/watch?v=J4xJSGpJioI&feature=relmfu 92
Return to Table of Contents
94. EMSC Prehospital Protocols
All Pediatric Seizure care guidelines follow
this sequence:
Initial Medical Care/Assessment
Protect the child from Injury
Vomiting and Aspiration precautions
THE NEXT STEPS DEPEND
ON THE LEVEL OF CARE
OF THE RESPONDER
94
95. EMSC Prehospital Protocols
Here are examples of prehospital pediatric seizure protocols
EMERGENCY MEDICAL RESPONDER
CARE GUIDELINE
BLS CARE GUIDELINE
ILS CARE GUIDELINE
ALS CARE GUIDELINE
95
Source: Illinois EMSC Pediatric Prehospital Protocols
97. Sample ED Status Epilepticus Guidelines
Please give credit to any of the following resources you use
Children’s Memorial Hospital
Emergency Department Management Guideline
Advocate Condell Medical Center
Pediatric Emergency Department Clinical Guideline
University or Chicago Comer Children’s hospital
Pediatric Emergency Department Clinical Guideline: Status
Epilepticus
97
99. Neonatal Seizures
Neonatal seizures can be difficult to diagnose
o May consist of very subtle and unusual physical
signs
Eye deviation, staring episodes, winking
In neonates, onset of seizure activity is important in
determining etiology
o First 24 - 72 hours of life
Ischemic hypoxia
72 hours to 1 week of age
o Familial neonatal seizures
Metabolic disorders
99
100. Neonatal Seizures
Beyond the standard history, ask about the
pregnancy, labor and delivery and maternal risk
factors
Physical exam should include head circumference
and careful inspection for dysmorphic features and
cutaneous lesions.8
Consult with a pediatric neurologist to identify
infantile seizure disorders
100
101. Neonatal Seizures:
Status Epilepticus
Assess A, B, C’s
Evaluate and maintain airway
Provide 100% oxygen
Establish vascular access
Obtain rapid glucose
Administer Medications
PHENobarbital 20 mg/kg IV
Repeat up to 40 mg/kg total dose
Contact Neurology
101