|
PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
|||||||||
Round one
14. Prolonged convulsion
Statement 14 (Prolonged convulsions)
(i) A convulsion needs treating if it has not stopped after 10 minutes
|
%
Agree |
%
Disagree |
Result |
|
87.5% |
9.4% |
Included |
|
Position |
Comments |
|
ED P |
Start treating before |
|
Paed |
treatment should ideally start within 5 minutes of onset of seizure |
|
Radiol |
Sooner |
|
PICU |
if seizure >4 mins |
|
Neuro |
Perhaps after shorter period of time e.g. 5 mins, especially if serial |
(ii) The treatment of a prolonged convulsion (i.e. lasting longer than 10 minutes) should follow the A.P.L.S. guidance (Advanced Paediatric Life Support)
|
%
Agree |
%
Disagree |
Result |
|
100% |
0% |
Included |
|
Position |
Comments |
|
Neuro |
Or similar |
|
Neuro |
[Can’t read] – it in an good or any |
|
Endo |
?included in document |
-
(iii) If the convulsion is prolonged (i.e. lasting longer than 10 minutes) and the child is not known to have epilepsy, then the core investigations (“core investigations” are those agreed upon in statement 7e) should be sent at presentation
|
%
Agree |
%
Disagree |
Result |
|
87.5% |
3.1% |
Included |
|
Position |
Comments |
|
ED |
easier to answer when “core investigations” agreed |
|
Endo |
And Ca/Mg – occasional primary hypoparathyroidism |
(iv) If the convulsion is prolonged (i.e. lasting longer than 10 minutes) and the child is under a year old, then plasma calcium and magnesium should be requested as well as the core investigations (“core investigations” are those agreed upon in statement 7e) at presentation
|
%
Agree |
%
Disagree |
Result |
|
90.3% |
3.2% |
Included |
|
Position |
Comments |
|
Renal |
I had assumed electrolytes included at least calcium |
|
Paed |
Baseline Ca/Mg/Sugar/Temp |
(v) If a child has had a convulsion lasting more than 10 minutes a lumbar puncture is contraindicated for at least the following 24 hours after the convulsion has stopped
|
%
Agree |
%
Disagree |
Result |
|
20% |
72% |
Excluded |
|
Position |
Comments |
|
Metab |
Is the child febrile or not? |
|
Neuro |
Depends on recovery, indication for LP, neuroimaging, etc |
|
ED P |
Unless child seems very stable |
|
ED P |
OK once woken up fully |
|
Neuro S |
Check a scan first but not contraindicated |
|
Neuro |
Depends on the GCS after the convulsion |
(vi) If the plasma sodium is less than 125 mmol/l and the convulsion is ongoing, an infusion of 3% saline (5 ml/kg) should be given over one hour
|
%
Agree |
%
Disagree |
Result |
|
64% |
20% |
Discussed
in round 2 |
|
Position |
Comments |
|
Paed |
the deficit needs to be calculated and half correction done. |
|
ED P |
Ongoing how long? continue to treat seizure, fluid restrict, then consider… consider early if Na lower – fitting secondary to Na 125mmol ? unusual |
|
PICU N |
need to check protocol |
|
Neuro S |
Sounds too fast - ?risk of pontine myelinolysis – 1.8% saline more standard |
(vii) If the ionized calcium is less than 0.75 mmol/l and the convulsion is ongoing, an infusion of 0.3ml/kg of 10% calcium gluconate should be given over 5 minutes
|
%
Agree |
%
Disagree |
Result |
|
95% |
0% |
Included |
|
Position |
Comments |
|
ED P |
I would look up dose |
|
PICU N |
need to check protocol |
(viii) If the plasma calcium is less than 1.7 mmol/l and the convulsion is ongoing, an infusion of 0.3ml/kg of 10% calcium gluconate should be given over 5 minutes
|
%
Agree |
%
Disagree |
Result |
|
81.8% |
4.5% |
Included |
|
Position |
Comments |
|
Metab |
We get ionised Ca only from the ITU gas analyser, so I am less familiar with this |
|
Metab |
What is the plasma albumin? |
|
ED P |
I would look up dose |
|
Neuro |
unlikely the cause |
|
PICU N |
need to check protocol |
(ix) If the serum magnesium is less than 0.75 mmol/L and the convulsion is ongoing, an infusion of magnesium sulphate 50mg/kg should be given over 10 minutes
|
%
Agree |
%
Disagree |
Result |
|
68.4% |
21.1% |
Discussed
in round 2 |
|
Position |
Comments |
|
|
would give magnesium slower in view of haemodynamic consequences |