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PEDI | Seizures
Description
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
◦ 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:
◦ 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),.
4. Red Flags
If you see these, the seizure is likely secondary to a dangerous underlying condition rather than idiopathic epilepsy.
• Sunset Eyes: Sclera visible above the iris. Indicates increased Intracranial Pressure (ICP) (e.g., hydrocephalus).
• Bulging Fontanel: In infants, indicates increased ICP, meningitis, or hydrocephalus,.
• Petechial/Purpuric Rash: Immediate medical emergency suggesting meningococcemia (bacterial meningitis).
• Cushing Triad (Late Sign of ICP): Hypertension (widening pulse pressure), Bradycardia, and Irregular respirations. Signs of impending herniation