1) Seizures in children can range from simple febrile seizures caused by fever to prolonged status epilepticus that requires medical intervention.
2) The diagnosis and treatment of seizures involves identifying the seizure type, treating any underlying medical conditions, and using benzodiazepines, antiepileptic drugs, or electrolyte supplementation as appropriate.
3) Philippine clinical practice guidelines recommend lumbar puncture for children under 18 months with a first simple febrile seizure but not routine neuroimaging or anticonvulsant prophylaxis for recurrent febrile seizures.
Disorders of the neuromuscular junction include Myasthenia gravis, Lambert-Eaton myasthenic syndrome, Botulism, Tetanus, Strychnine intoxication, Organophosphates poisoning and neuromyotonia. Pharmacology of the NMJ is also reviewed in brief.
Slideshows on febrile seizures.. Simple and basic details available. For medical students, housemen and training doctors who wish to revise on the topic.
Author: Danielle Cassidy, Pharm.D., BCPS
Audience: Third year pharmacy students at University of Colorado School of Pharmacy
Background: describes common causes of seizures, differentiates dosing of antiepileptic drugs in pediatrics vs. adults, common risk factors associated with febrile seizures, treatment of febrile seizures, treatment of status epilepticus (inpatient & outpatient), & how to dispense/counsel parents on the administration of Diastat.
Disorders of the neuromuscular junction include Myasthenia gravis, Lambert-Eaton myasthenic syndrome, Botulism, Tetanus, Strychnine intoxication, Organophosphates poisoning and neuromyotonia. Pharmacology of the NMJ is also reviewed in brief.
Slideshows on febrile seizures.. Simple and basic details available. For medical students, housemen and training doctors who wish to revise on the topic.
Author: Danielle Cassidy, Pharm.D., BCPS
Audience: Third year pharmacy students at University of Colorado School of Pharmacy
Background: describes common causes of seizures, differentiates dosing of antiepileptic drugs in pediatrics vs. adults, common risk factors associated with febrile seizures, treatment of febrile seizures, treatment of status epilepticus (inpatient & outpatient), & how to dispense/counsel parents on the administration of Diastat.
Epilepsy case presentation by mehreen taj IVth parm DMehreen taj
Epilepsy:Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures.The main causes of Epilepsy and resultant seizures include Meningitis, head injury or trauma, stroke, brain tumour, high fever (Febrile Seizure), and parasite infection Neuro-cysticercosis. The main triggering factors include light, noise, sleep loss, alcohol intake and cigarette smoking.
Epileptic seizures vary in intensity and symptoms depending on what part of the brain is involved. In partial seizures, the most common form of seizure in adults, only one area of the brain is involved. Partial seizures are classified as simple partial, complex partial (also known as psychomotor), and absence (also known as myoclonic or petit mal) seizure.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
29. syncope
Preceded by
• dizziness
• weakness
• tunnel vision
• pallor
• diaphoresis
Associated with
• brief loss of
consciousnes
s
• quick
recovery with
no postictal
state
108. Antipyretic drugs are used to
lower fever and should not be
relied upon to prevent the
recurrence of febrile seizures
Philippine CPG
109. For a first simple febrile seizure
the use of intermittent or continuous
(phenobarbital or diazepam)
is not recommended for
the prevention of recurrent febrile seizures.
Philippine CPG
paroxysmal involuntary motor activity
and/or
changes in behavior
caused by synchronous firing of a group of neurons in the brain
It a balance between 2 neurotransmitters, glutamate and GABA.
A seizure’s electrical activity can be captured in an electroencephalogram (EEG).
However, seizure activity is not always visible in an EEG, and the diagnosis of epilepsy is made clinically.
Children less than 5 years old are most susceptible to seizure because of the immaturity of the nervous
where excitatory activity predominates and inhibitory systems are undeveloped
This is known as the period of vulnerability.
children with epilepsy are at a significant risk for cognitive impairment and behavioral abnormalities.
It is difficult to distinguish the relative contributions of the effect of the seizures from the underlying CNS disease and from the effect of anticonvulsants.
A single prolonged seizure which lasts >30 minutes has been shown to damage the brain
A single prolonged seizure (>30 minutes) has been shown to damage the brain, particularly the temporal lobes and hippocampus.
Seizure disorders are the most common neurologic disorders of
childhood; 4 to 10% of children suffer at least one seizure in the
first 16 years of life.
For epidemiologic purposes epilepsy is considered to be present when ≥2 unprovoked seizures occur in a time frame of >24 hr.
The cumulative lifetime incidence of epilepsy is 3%, and more than half of the cases start in childhood.
The annual prevalence is 0.5-1%.
Thus, the occurrence of a single seizure or of febrile seizures does not necessarily imply the diagnosis of epilepsy.
Seizure disorders are the most common neurologic disorders of childhood
4 to 10% of children suffer at least one seizure in the first 16 years of life
Risk factors for occurrence of subsequent epilepsy. Neurodevelopmental abnormalities and focal complex seizures has the highest risk for developing epilepsy
Tonic seizures are stiffening or straightening of the arms or legs
clonic seizure activity is the repeated contraction and relaxation of muscles resulting in repeated jerking.
Generalized tonic-clonic seizures involve the entire body and are analogous to generalized convulsive or grand mal seizures.
Generalized tonic-clonic seizures involve the entire body and are analogous to generalized convulsive or grand mal seizures.
Aura phase of a tonic-clonic seizure may manifest as light headedness, dizziness, confusion or hallucinations.
Followed by the tonic phase and the clonic phase.
Table 129-2 outlines a number of clinical signs and symptoms of seizures.
One of the most important issues is to decide whether or not a seizure has occurred.
Taking a good history, conducting a thorough examination, and recognizing the subtle differences between seizures and
other conditions that may masquerade as seizures are essential to making the correct diagnosis.
Most of the conditions masquerading as seizures are benign, and thus minimal evaluation is needed.
Breath-holding is cyanosis provoked by upsetting or scolding and it usually used for secondary gain.
Cataplexy is a transient loss of mucle tone and Narcolepsy is an attack of irrepressible sleep with cataplexy
Vasovagal attacks are caused by decreased blood flow to the brain.
If the diagnosis is still unclear, EEG and outpatient neurologic consultation may be warranted.
Syncope is the most common condition that may be mistaken for seizures
Syncope is commonly preceded by dizziness, weakness, tunnel vision, pallor, and diaphoresis (presyncopal aura).
It is also associated with a brief loss of consciousness and a quick recovery with no postictal state.
Seizures, however, may be preceded by an aura but usually do not have a provoking factor noted before the event. Seizures are associated with cyanosis, tongue biting, rhythmic motor activity, incontinence, and a slow recovery
and postictal state.
General approach to evaluation of pediatric seizures
Children with known seizure disorder may be non-compliant of may have outgrown medication dose.
Seizures may also manifest after a head trauma causing intracranial injury
Brain tumors, Atrioventricular Malformations, Stroke and abusive head trauma seizures can be identified by doing a neurological examination.
Febrile seizures are patients with fever with unremarkable focal neurologic exam
Febrile seizures are patients with fever with unremarkable focal neurologic exam
Electrolyte abnormalities especially hypoglycemia, hyponatremia, hypocalcemia and hypomagnesemia may manifest as seizure as well.
Seizures may be generalized or partial.
a seizure starting as partial can become generalized and vice versa.
For generalized seizure
Generalized seizure can be convulsive where it involves both hemispheres of the brain are involved and rhythmic motor stiffening and/or shaking affects both sides of the body.
A nonconvulsive generalized seizure also involves both hemispheres of the brain but manifests no motor activity—seizure activity is recognizable only on EEG.
During both convulsive and nonconvulsive generalized seizures, the patient loses consciousness and a postictal period follows.
Other generalized seizures are
An absence seizure manifests as an episode of staring without a postictal state.
In atonic seizures a patient suddenly lacks muscle tone and drops to the ground.
Myoclonic seizures occur when a patient has a sudden, brief total body jerking movement.
An absence seizure manifests as an episode of staring without a postictal state.
In atonic seizures a patient suddenly lacks muscle tone and drops to the ground.
Myoclonic seizures occur when a patient has a sudden, brief total body jerking movement.
An absence seizure manifests as an episode of staring without a postictal state.
In atonic seizures a patient suddenly lacks muscle tone and drops to the ground.
Myoclonic seizures occur when a patient has a sudden, brief total body jerking movement.
Partial seizures are focal, involving only part of the brain, with manifestations correlating with the affected area.
Partial seizures are focal, involving only part of the brain, with manifestations correlating with the affected area.
In a simple partial seizure, the patient is awake.
Complex partial seizure is a focal seizure in which the patient is unconscious.
Febrile seizures are categorized as simple or complex
The definition of a simple febrile seizure is a generalized tonic-clonic seizure lasting <15 minutes with a fever ≥38°C (≥100.4°F) in a child 6 months to 5 years of age that occurs only once in a 24-hour period
The definition of a simple febrile seizure is a generalized tonic-clonic seizure lasting <15 minutes with a fever ≥38°C (≥100.4°F) in a child 6 months to 5 years of age that occurs only once in a 24-hour period
The definition of a simple febrile seizure is a generalized tonic-clonic seizure lasting <15 minutes with a fever ≥38°C (≥100.4°F) in a child 6 months to 5 years of age that occurs only once in a 24-hour period
The definition of a simple febrile seizure is a generalized tonic-clonic seizure lasting <15 minutes with a fever ≥38°C (≥100.4°F) in a child 6 months to 5 years of age that occurs only once in a 24-hour period
The definition of a simple febrile seizure is a generalized tonic-clonic seizure lasting <15 minutes with a fever ≥38°C (≥100.4°F) in a child 6 months to 5 years of age that occurs only once in a 24-hour period
The definition of a simple febrile seizure is a generalized tonic-clonic seizure lasting <15 minutes with a fever ≥38°C (≥100.4°F) in a child 6 months to 5 years of age that occurs only once in a 24-hour period
Complex febrile seizures are defined as seizures with fever that last >15 minutes, that recur within a 24-hour period, that are focal, or that occur in children <6 months or >5 years of age without any signs of serious infection.
Complex febrile seizures are defined as seizures with fever that last >15 minutes, that recur within a 24-hour period, that are focal, or that occur in children <6 months or >5 years of age without any signs of serious infection.
Complex febrile seizures are defined as seizures with fever that last >15 minutes, that recur within a 24-hour period, that are focal, or that occur in children <6 months or >5 years of age without any signs of serious infection.
Complex febrile seizures are defined as seizures with fever that last >15 minutes, that recur within a 24-hour period, that are focal, or that occur in children <6 months or >5 years of age without any signs of serious infection.
Complex febrile seizures are defined as seizures with fever that last >15 minutes, that recur within a 24-hour period, that are focal, or that occur in children <6 months or >5 years of age without any signs of serious infection.
Anticonvulsant therapy is not recommended for simple febrile seizures.
Side effects of the medications outweigh the minor risks of seizure recurrence.
Although antipyretics are indicated in children with fever, there is no evidence that antipyretics can prevent subsequent febrile seizures.
Status epilepticus is a “prolonged” seizure or recurrent seizures lasting >5
minutes without the patient’s regaining consciousness. Rapid cessation of
status epilepticus is important to prevent irreversible neuronal damage.
Refractory status epilepticus is a prolonged seizure that cannot be controlled with two or more standard doses of treatment.
Most seizures stop within 5 minutes and do not require medical treatment.
Status epilepticus (seizure activity lasting for >5 minutes or
multiple seizures over a period of >5 minutes) is more responsive to
medications when treated early, and medical treatment becomes less
effective with time.
Status epilepticus is more responsive to medications when treated early, and medical treatment becomes less
effective with time.
Children may have been treated at home or by EMS personnel.
Prehospital first-line treatment in most cases is a benzodiazepine
However, not all benzodiazepines or routes are available in the prehospital setting, and establishing IV access can be difficult.
Benzodiazepines may be given IO, intranasally, PR, or buccally if an IV is difficult to place.
Rectal diazepam is one “rescue” medication commonly used at home and by EMS personnel.
The advantage is that no refrigeration or IV line is needed.
The disadvantage is its short half-life and the need for rectal administration.
Midazolam, also an effective rescue medication, can be safely given intranasally using a mucosal atomization device Midazolam can also be given buccally.
Lorazepam is not generally used in the prehospital setting because of its need for refrigeration and delivery via an IV line.
There is some evidence that intranasal lorazepam may be used to treat status epilepticus using a MADR.
Administer oxygen by face mask and institute continuous pulse oximetry.
IV access is important for administering most medications
Order a complete blood count (CBC), full chemistry panel, hepatic and renal studies, and anticonvulsant levels, if appropriate, when an IV is placed.
Other studies may be needed depending upon the suspected underlying cause of seizures.
Consider CNS infection in the child with fever and status epilepticus.
The decision to intubate is clinical. Intubate for apnea and persistent hypoxia.
Determining blood gas concentrations and the use of paralytic with intubation are not recommended
because the seizure itself causes a metabolic and respiratory acidosis and the use of paralytic may obscure the ability to assess ongoing seizure activity
continuous EEG monitoring should be arranged for intubated patients with status epilepticus
Benzodiazepines are the initial treatment for status epilepticus.
They are initially preferred over other medications because of their rapid onset of action
They act by binding to GABA receptors, which are inhibitory.
IV lorazepam is generally preferred over other benzodiazepines if an IV line is available
Because of its longer duration of action and some evidence that it has fewer side effects than the other benzodiazepines.
If two doses did not stop the seizure, additional doses are unlikely to be successful and it would increase the risk for respiratory depression. That is why initial benzo treatment should be limited to 2 doses
This is lifted from the textbook.
Phenytoin and fosphenytoin, its prodrug, inhibit neurons from firing by stabilizing sodium channels and reducing neuronal calcium uptake.
Phenobarbital like Benzos, bind to GABA receptors
Fosphenytoin is preferred over phenytoin, because its administration is safer.
Phenytoin may precipitate in an IV line, causing significant injury to the surrounding tissue.
IV phenytoin may also result in hypotension or cardiac arrhythmias and must be given slowly.
Fosphenytoin is usually the preferred second-line treatment over phenobarbital, mainly because it differs from the benzodiazepines.
Benzodiazepines and phenobarbital have the same mechanism of action (both bind GABA receptors).
Phenobarbital is preferred over phenytoin or fosphenytoin in children who have allergies to fosphenytoin or phenytoin, present with a febrile illness, or are <2 years of age.
Side effects of phenobarbital are sedation and cardiorespiratory depression, which may be amplified by benzodiazepines.
Valproic acid and Levetiracetam are used in status epilepticus and is effective for partial and generalized seizures.
However, valproic acid should be used with caution in children at risk for metabolic disease,
because in rare cases it may cause hepatic failure in these children.
It inhibits a calcium-dependent neurotransmitter and affects GABA receptors.
Levetiracetam is eliminated solely via renal excretion and has no liver metabolism.
Most laboratory results are not immediately available when treating status epilepticus. can cause seizures.
Seizures caused by low electrolyte levels are poorly responsive to medication but do respond to replacement electrolyte therapy.
Hypoglycemia is defined as a glucose level of <50 milligrams/dL regardless of whether symptoms exist. There are multiple causes of hypoglycemia, but the most common cause in children is decreased intake of glucose. Seizures can occur with hypoglycemia, so glucose level should be measured in all patients presenting with seizures
Excessive water drinking can lead to hyponatremia (<135 mEq/L). Hyponatremia is most commonly seen in infants <6 months of Age and sometimes in athletes. Babies who drink several bottles of water a day or who drink dilute infant formula are at risk for hyponatremia. Athletes can also suffer from water intoxication.
If a patient is actively experiencing seizure, the treatment of choice is 3% NaCl.
An infusion of 20 mL/kg of 0.9% NaCl should be started immediately for patients in
status epilepticus if delivery of 3% NaCl is delayed.
3% NaCl (513 mEq/1000 mL): Na deficit in total mEq = [(weight in kg) × (130 – serum Na level) × 0.6] over 20 minutes
or
3% NaCl: 4 to 6 mL/kg over 20 minutes
If there is no seizure activity but the sodium level is below 120 mEq/L,
4 to 6 mL/kg of 3% NaCl or 20 mL/kg of normal saline can be given over
an hour. The sodium level should be rechecked after the bolus to see if a
second bolus is necessary
Hypocalcemia is caused by abnormal calcium absorption, excretion, or distribution and can also cause seizures Hypocalcemia is more common in neonates and young infants and may be associated with congenital anomalies such as DiGeorge syndrome.
Hypomagnesemia is defined as a serum magnesium
level of <1.5 mEq/L. There are many causes of low magnesium level, but the
major causes are GI and renal losses (see Chapter 142, Fluid and Electrolyte
Therapy in Infants and Children). Seizures due to hypomagnesemia are less
common than those due to low levels of sodium, glucose, and calcium. The
treatment is magnesium, 50 milligrams/kg IV infused over 20 minutes.
After providing oxygen support, IV access must be obtained
Benzodiazepines are used for initial treatment, preferably lorazepam
To rule out the alternative diagnosis of meningitis
For those children 18 months of age or older, lumbar puncture should be performed in the presence of clinical signs
of meningitis such as meningeal signs and sensorial changes.
Neuroimaging studies should not be routinely performed.
Antipyretic drugs are used to lower fever and should not be relied upon to prevent the recurrence of febrile seizures.
For a first simple febrile seizure, the use of intermittent (phenobarbital or diazepam) as well as continuous (phenobarbital or valproic acid) anticonvulsants is not recommended for the prevention of recurrent febrile seizures.
Although anticonvulsants can reduce the recurrence of febrile seizures, the adverse side effects of these drugs do not warrant their use in this benign disorder. Electroencephalogram should not be routinely requested.
For those children 18 months of age or older, lumbar puncture should be performed in the presence of clinical signs
of meningitis such as meningeal signs and sensorial changes.
Neuroimaging studies should not be routinely performed.
Antipyretic drugs are used to lower fever and should not be relied upon to prevent the recurrence of febrile seizures.
For a first simple febrile seizure, the use of intermittent (phenobarbital or diazepam) as well as continuous (phenobarbital or valproic acid) anticonvulsants is not recommended for the prevention of recurrent febrile seizures.
Although anticonvulsants can reduce the recurrence of febrile seizures, the adverse side effects of these drugs do not warrant their use in this benign disorder. Electroencephalogram should not be routinely requested.
In order to rule out the alternative diagnosis of meningitis, lumbar puncture should be performed in all children below 18 months with a first simple febrile seizure.
For those children 18 months of age or older, lumbar puncture should be performed in the presence of clinical signs
of meningitis such as meningeal signs and sensorial changes.
Neuroimaging studies should not be routinely performed.
Antipyretic drugs are used to lower fever and should not be relied upon to prevent the recurrence of febrile seizures.
For a first simple febrile seizure, the use of intermittent (phenobarbital or diazepam) as well as continuous (phenobarbital or valproic acid) anticonvulsants is not recommended for the prevention of recurrent febrile seizures.
Although anticonvulsants can reduce the recurrence of febrile seizures, the adverse side effects of these drugs do not warrant their use in this benign disorder. Electroencephalogram should not be routinely requested.
In order to rule out the alternative diagnosis of meningitis, lumbar puncture should be performed in all children below 18 months with a first simple febrile seizure.
For those children 18 months of age or older, lumbar puncture should be performed in the presence of clinical signs
of meningitis such as meningeal signs and sensorial changes.
Neuroimaging studies should not be routinely performed.
Antipyretic drugs are used to lower fever and should not be relied upon to prevent the recurrence of febrile seizures.
For a first simple febrile seizure, the use of intermittent (phenobarbital or diazepam) as well as continuous (phenobarbital or valproic acid) anticonvulsants is not recommended for the prevention of recurrent febrile seizures.
Although anticonvulsants can reduce the recurrence of febrile seizures, the adverse side effects of these drugs do not warrant their use in this benign disorder. Electroencephalogram should not be routinely requested.
For a first simple febrile seizure, the use of intermittent (phenobarbital or diazepam) as well as continuous (phenobarbital or valproic acid) anticonvulsants is not recommended for the prevention of recurrent febrile seizures.
Although anticonvulsants can reduce the recurrence of febrile seizures, the adverse side effects of these drugs do not warrant their use in this benign disorder. Electroencephalogram should not be routinely requested.
Electroencephalogram should not be routinely requested.