Clinical Approach

Clinical Features:

• 1) continuous seizure or convulsion more 30 min 

Investigations: 

• 1)CBC
• 2)CSF study
• 3)Serum calcium
• 4)RBS 
• 5)Serum Mg
• 6)ABG 
• 7)CT Screen of brain
• 8)EEG 

Rx: 

ABCDEFG (ABC's & Don’t Ever Forget the Glucose) 

At 1st check CBG if pt hypoglycemic then manage accordingly. 

1)ABC management 

A-Airway(Check Nose,oral cavity, Throat & Pharynx for any secretion or vomitus দিয়ে  বন্ধ আছে কি না।) 

➡️mx: 

• 1)clearing airway secretions, vomitus by suction or finger sweep  maneuver 
• 2)open up the air way by head tilt-chin lift maneuver 
• 3)puting airway tube 
• 4)ET tube may need to maintain airway  

B-Breathing (Check Respiratory rate,Flaring of alae,cyanosis,Chest movement, O2 saturation)

➡️mx:if pt caynosis or dyspnoea 

1)O2 inhalation by 

• Nasal cannula (1-2L/min) or
• Face mask(5L/min) or 
• Bag & Mask ventilation  or 
• ET intubation.  Or 
• Mechanical Ventilation 

C-circulation ( check Pulse,BP,pulse pressure, CRT,ECG)

➡️Mx: Do I/V cannula then start baby saline/Normal saline 

💉if pt is in shock : Low BP + CRT more then 3 seconds 

• -Give I/V Normal saline bolus (20ml/kg)
• -Reassess and if no improve then repeat bolus 

💉If shock persist then give 

• inj.Dopamine (10-20microgm/kg/min)

or 

• inj.Dobutamine(10-20microgm/kg/min)

Convulsion Control :

🎴1st line drug:(0-5 min)

• Inj.Lorapam(lorazepam) 0.1 mg/kg/dose, I/V,Max 4 mg slowly over (2-5 min) 

OR

• Inj.Diazepam (sedil) 0.2 mg/kg,(max 10 mg) over (2-5 min)

➡️If I/V Access not possible then...

• Buccal Midazolam 0.5mg/kg (max 10 mg) 

Or,

• P/R  inj.Diazepam 0.5 mg/kg (max-20mg)

Or, 

• Inj.Milam(midazolam) 10 mg,I/M 

🎴2nd line drug(if seizure not controlled) :(10-15 min)

• inj.Iracet(Levetiracetam) 60 mg/kg, I/V (max-4500mg) 

Or,

• Inj.Fosfen(Fosphenytoin) 20mg/kg,I/V(max-1500mg)

Or,

• inj.Valex([post id="480" title="Sodium-Valproate"]), 40mg/kg,I/V (max-3000mg)

🎴If not controlled seizure..... Then used drugs

• inj.propofol, 2-5 mg/kg,I/V, then infusion 2-10mg/kg/hour Or,
• inj.Midazolam, 0.2 mg/kg,I/V then infusion 0.05-2 mg/kg/hour Or,
• Inj.ketamin,I/V, 0.5-3mg/kg then infusion 0.3-4mg/kg/hour Or,
• inj.phenobarbital 10-20mg/kg, i/v, 50-75 mg/min

🚑🚑Referred pt higher centre... 🚑🚑

🌎🌎সময়ই জীবনের সবচেয়ে বড় শিক্ষক, কারণ সময় যা শেখায় তা আর কেউ শেখাতে পারে না।🌎🌎