Peds0315 Seizures.pdf


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VISIT US AT
BOOTH # 203
AT THE ACEP PEDIATRIC
ASSEMBLY IN NEW YORK, NY,
MARCH 24-25, 2015

Emergency Department
Management Of Seizures In
Pediatric Patients
Abstract
Seizures account for 1% of all emergency department visits for children, and the etiologies range from benign to life-threatening. The
challenge for emergency clinicians is to diagnose and treat the lifethreatening causes of seizures while avoiding unnecessary radiation
exposure and painful procedures in patients who are unlikely to have
an emergent pathology. When treating patients in status epilepticus,
emergency clinicians are also faced with the challenge of choosing
anticonvulsant medications that will be efficacious while minimizing
harmful side effects. Unfortunately, evidence to guide the evaluation
and management of children presenting with new and breakthrough
seizures and status epilepticus is limited. This review summarizes
available evidence and guidelines on the diagnostic evaluation of firsttime, breakthrough, and simple and complex febrile seizures. Management of seizures in neonates and seizures due to toxic ingestions is
also reviewed.

Editor-in-Chief

March 2015

Volume 12, Number 3
Authors
Genevieve Santillanes, MD, FAAP, FACEP
Assistant Professor of Emergency Medicine, Keck School of
Medicine, University of Southern California, LAC+USC Medical
Center, Los Angeles, CA
Quyen Luc, MD
Assistant Professor of Clinical Neurology, Keck School of
Medicine, University of Southern California, Children's Hospital
Los Angeles, Los Angeles, CA
Peer Reviewers
Ilene Claudius, MD
Associate Professor, University of Southern California, Keck
School of Medicine Department of Emergency Medicine, Los
Angeles, CA
Sara Winchester, MD
Child Neurologist, Child Neurology Center of Northwest
Florida, Gulf Breeze, FL
CME Objectives
Upon completion of this article, you should be able to:
1.
Identify life-threatening secondary causes of pediatric
seizures.
2. Assess which patients require emergent neuroimaging.
3. Predict when laboratory investigations are likely to
change patient management.
4. Identify options for treatment of status epilepticus that is
unresponsive to benzodiazepines.
Prior to beginning this activity, see “Physician CME
Information” on the back page.

Ilene Claudius, MD
Therapeutics; Research Director,
Associate Professor of Emergency
Pediatric Emergency Medicine, BC
Adam E. Vella, MD, FAAP
Medicine, Keck School of Medicine
Children's Hospital, Vancouver, BC,
Associate Professor of Emergency
of the University of Southern
Canada
Medicine, Pediatrics, and Medical
California, Los Angeles, CA
Alson S. Inaba, MD, FAAP
Education, Director Of Pediatric
Ari Cohen, MD
Associate Professor of Pediatrics,
Emergency Medicine, Icahn
University of Hawaii at Mãnoa
School of Medicine at Mount Sinai, Chief of Pediatric Emergency
Medicine Services, Massachusetts
John A. Burns School of Medicine,
New York, NY
General Hospital; Instructor in
Division Head of Pediatric
Associate Editor-in-Chief
Pediatrics, Harvard Medical
Emergency Medicine, Kapiolani
School, Boston, MA
Medical Center for Women and
Vincent J. Wang, MD, MHA
Children, Honolulu, HI
Associate Professor of Pediatrics, Marianne Gausche-Hill, MD,

Melissa Langhan, MD, MHS
Associate Professor of Pediatrics,
Fellowship Director, Pediatric
Emergency Medicine, Director of
Education, Pediatric Emergency
Medicine, Yale School of Medicine,
New Haven, CT

Editorial Board

Joshua Nagler, MD
Assistant Professor of Pediatrics,
Harvard Medical School;
Fellowship Director, Division of
Emergency Medicine, Boston
Children’s Hospital, Boston, MA

Keck School of Medicine of the
University of Southern California;
Associate Division Head,
Division of Emergency Medicine,
Children's Hospital Los Angeles,
Los Angeles, CA

Jeffrey R. Avner, MD, FAAP
Professor of Clinical Pediatrics
and Chief of Pediatric Emergency
Medicine, Albert Einstein College
of Medicine, Children’s Hospital at
Montefiore, Bronx, NY

FACEP, FAAP
Madeline Matar Joseph, MD, FAAP,
Professor of Clinical Medicine,
FACEP
David Geffen School of Medicine
Professor of Emergency Medicine
at the University of California at
and Pediatrics, Chief and Medical
Los Angeles; Vice Chair and Chief,
Director, Pediatric Emergency
Division of Pediatric Emergency
Medicine Division, University
Medicine, Harbor-UCLA Medical
of Florida Medical SchoolCenter, Los Angeles, CA
Jacksonville, Jacksonville, FL
Michael J. Gerardi, MD, FAAP,
FACEP, President-Elect
Associate Professor of Emergency
Medicine, Icahn School of
Medicine at Mount Sinai; Director,
Pediatric Emergency Medicine,
Goryeb Children's Hospital,
Morristown Medical Center,
Morristown, NJ

Stephanie Kennebeck, MD
Associate Professor, University
of Cincinnati Department of
Pediatrics, Cincinnati, OH
Anupam Kharbanda, MD, MS
Research Director, Associate
Fellowship Director, Department
of Pediatric Emergency Medicine,
Children's Hospitals and Clinics of
Minnesota, Minneapolis, MN

Steven Bin, MD
Associate Clinical Professor,
Division of Pediatric Emergency
Medicine, UCSF Benioff Children’s Sandip Godambe, MD, PhD
Hospital, University of California,
Vice President, Quality & Patient
Tommy Y. Kim, MD, FAAP, FACEP
San Francisco, CA
Safety, Professor of Pediatrics and Assistant Professor of Emergency
Emergency Medicine, Attending
Richard M. Cantor, MD, FAAP,
Medicine and Pediatrics, Loma
Physician, Children's Hospital
FACEP
Linda University Medical Center and
of the King's Daughters Health
Professor of Emergency Medicine
Children’s Hospital, Loma Linda, CA;
System, Norfolk, VA
and Pediatrics, Director, Pediatric
California Emergency Physicians,
Emergency Department, Medical
Ran D. Goldman, MD
Riverside, CA
Director, Central New York
Professor, Department of Pediatrics,
Poison Control Center, Golisano
University of British Columbia;
Children's Hospital, Syracuse, NY
Co-Lead, Division of Translational

Christopher Strother, MD
Assistant Professor, Director,
Undergraduate and Emergency
Simulation, Icahn School of
Medicine at Mount Sinai, New
York, NY

AAP Sponsor

Robert Luten, MD
Martin I. Herman, MD, FAAP, FACEP
Professor, Pediatrics and
Emergency Medicine, University of Professor of Pediatrics, Attending
Physician, Emergency Medicine
Florida, Jacksonville, FL
Department, Sacred Heart
Garth Meckler, MD, MSHS
Children’s Hospital, Pensacola, FL
Associate Professor of Pediatrics,
University of British Columbia;
International Editor
Division Head, Pediatric
Lara Zibners, MD, FAAP
Emergency Medicine, BC
Honorary Consultant, Paediatric
Children's Hospital, Vancouver,
Emergency Medicine, St Mary's
BC, Canada
Hospital, Imperial College Trust;
EM representative, Steering Group
ATLS®-UK, Royal College of
Surgeons, London, England

Pharmacology Editor

James Damilini, PharmD, MS,
BCPS
James Naprawa, MD
Clinical Pharmacy Specialist,
Associate Clinical Professor
Emergency Medicine, St.
of Pediatrics, The Ohio State
Joseph's Hospital and Medical
University College of Medicine;
Center, Phoenix, AZ
Attending Physician, Emergency
Department, Nationwide Children’s Quality Editor
Hospital, Columbus, OH
Steven Choi, MD
Steven Rogers, MD
Medical Director of Quality,
Assistant Professor, University of
Director of Pediatric Cardiac
Connecticut School of Medicine,
Inpatient Services, The Children’s
Attending Emergency Medicine
Hospital at Montefiore; Assistant
Physician, Connecticut Children's
Professor of Pediatrics, Albert
Medical Center, Hartford, CT
Einstein College of Medicine,
Bronx, NY