Episode Details

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1. The "Vital Few" Seizure Types (The 20% you will see most often)

While there are many seizure classifications, these three dominate pediatric presentations.

• Febrile Seizures (The Most Common)

◦ Who: The most common type of seizure in children under 5 years old, peaking between 12–18 months.

◦ Why: Triggered by a rapid rise in body temperature (usually >102.2°F or 39°C) associated with a viral infection, not a CNS infection.

◦ Outlook: Generally benign. Most stop by the time the child receives medical attention. They do not typically cause structural brain damage or cognitive decline.

• Tonic–Clonic (Formerly "Grand Mal")

◦ Presentation: The most dramatic type. Involves loss of consciousness, stiffening of the body (tonic), followed by rhythmic jerking (clonic).

◦ Aftermath: Always associated with a postictal phase (semicomatose or deep sleep for 30 minutes to 2 hours) where the child has no memory of the event,.

• Absence (Formerly "Petit Mal")

◦ Presentation: Often mistaken for "daydreaming" or inattention. Involves a sudden cessation of motor activity or speech with a blank facial expression. There is minimal to no motor activity (maybe slight eye twitching).

◦ Frequency: A child may experience countless attacks in a single day. Unlike tonic-clonic, there is no postictal state; the child resumes activity immediately.

2. The Core Management Protocols (The 20% of actions that ensure safety)

Nursing management prioritizes preventing injury and maintaining the airway over stopping the seizure immediately (unless it is Status Epilepticus).

• The "Do's" of Acute Management:

◦ Time the seizure: Note the onset and duration. If it lasts >5 minutes, it is a medical emergency.

◦ Positioning: Place the child on their side to open the airway and drain secretions.

◦ Safety: Ease the child to the floor if standing/sitting. Remove hazards from the area. Loosen tight clothing around the neck.

• The "Don'ts" (Critical Errors):

◦ Do NOT restrain the child.

◦ Do NOT force anything into the mouth (no tongue blades).

• Status Epilepticus (The Emergency):

◦ Defined as prolonged seizure activity (>30 minutes) or clustered seizures where the child does not regain consciousness in between.

◦ Action: Requires immediate medical intervention to prevent morbidity. Treatment includes airway management (ABCs), glucose monitoring, and rapid administration of benzodiazepines (IV/rectal Diazepam or Lorazepam),.

3. Pharmacology "Cheat Sheet" (The High-Yield Medications)

While there are many anticonvulsants, these categories represent the core pharmacological approach.

• Rescue Meds (Stop the seizure now):

◦ Benzodiazepines (Diazepam, Lorazepam, Midazolam): Used for Status Epilepticus or acute interruption of a seizure. Can be given IV, rectally (Diastat), or intranasally,.