Acute Illness in Children
Assignment One – Critical Analysis
Emergency Seizure Management
Seizures can quickly escalate into a life threatening emergency and are understandably a terrifying experience for parents and children. Emergency treatment includes: ensuring the patient is safe during the seizure (protect from injury, recovery position, ensuring airway is patent), termination of seizure activity and patient stabilization. Once the child is stabilised, investigations into what may have caused the seizure may begin. Seizures are termed ‘idiopathic’ when no cause can be identified, and the child should be referred to a neurologist as an outpatient. Idiopathic seizures account for 70% of unprovoked seizures in children (Sharieff & Hendry, 2011).
This essay will explore the current practice and guidelines of seizure management on an acute ward in Starhship children’s hospital. These practices and guidelines will be examined and critiqued, and also evaluated from the child and their family’s perspective.
Seizures are defined by Huff & Fountain (2011) and Blumstein & Friedman (2007) as unpredictable, involuntary, electrical discharges of cortical neurons within the brain, causing disturbed cerebral function resulting in altered function or behaviour. Seizures present in many different ways. The nature and characteristics of seizures are determined by the age of the child, the location of cortical involvement and the direction/speed of the electrical impulses (Blumstein & Friedman, 2007). Therefore there are many different types of seizures and seizure activity (Table 1 & 2). Behaviour during a seizure is determined by the location of the impulses within the brain and could manifest as a convulsion, unusual and sometimes repetitive body movement, change in level of consciousness or simply as a blank stare. During this, the patient can be completely aware of what is happening or they may be unconscious (Epilepsy Association of New Zealand, 2012). Table 1
Emergency Seizure Management
Seizures can quickly escalate into a life threatening emergency and are understandably a terrifying experience for parents and children. Emergency treatment includes: ensuring the patient is safe during the seizure (protect from injury, recovery position, ensuring airway is patent), termination of seizure activity and patient stabilization. Once the child is stabilised, investigations into what may have caused the seizure may begin. Seizures are termed ‘idiopathic’ when no cause can be identified, and the child should be referred to a neurologist as an outpatient. Idiopathic seizures account for 70% of unprovoked seizures in children (Sharieff & Hendry, 2011).
This essay will explore the current practice and guidelines of seizure management on an acute ward in Starhship children’s hospital. These practices and guidelines will be examined and critiqued, and also evaluated from the child and their family’s perspective.
Seizures are defined by Huff & Fountain (2011) and Blumstein & Friedman (2007) as unpredictable, involuntary, electrical discharges of cortical neurons within the brain, causing disturbed cerebral function resulting in altered function or behaviour. Seizures present in many different ways. The nature and characteristics of seizures are determined by the age of the child, the location of cortical involvement and the direction/speed of the electrical impulses (Blumstein & Friedman, 2007). Therefore there are many different types of seizures and seizure activity (Table 1 & 2). Behaviour during a seizure is determined by the location of the impulses within the brain and could manifest as a convulsion, unusual and sometimes repetitive body movement, change in level of consciousness or simply as a blank stare. During this, the patient can be completely aware of what is happening or they may be unconscious (Epilepsy Association of New Zealand, 2012). Table 1
References: Baysun, S., Aydin, O., Atmaca, E., & Gürer, Y. (2005). A comparison of buccal midazolam and rectal diazepam for the acute treatment of seizures. Clinical Pediatrics. 44(177), 771-776. doi:10.1177/000992280504400904 Bhattacharyya, M., Kalra, V Blumstein, M. & Friedman, M. (2007). Childhood seizures. Emergency Medicine Clinics of North America. 25. 1061–1086. doi:10.1016/j.emc.2007.07.010 Body, R Goyal, M. & Wiznitzer, M. (2006). Emergency management of seizures in children. The Lancet. 367(9522), 1555-1556. Hart, Y Mastriani, K., Williams, V., Hulsey, T., Wheless, J. & Maria, B. (2008). Evidence-based versus reported epilepsy management practices. Journal of Child Neurology. 23(5), 507-514. doi:10.1177/0883073807309785 Pellock, J Rainbow, J., Browne, G. & Lam, L. (2002). Controlling seizures in the prehospital setting: Diazepam or midazolam. Journal of Paediatrics and Child Health. 38(6), 582-586. doi:10.1046/j.1440- 1754.2002.00046.x Rocha, L., Lopez-Meraz, M., Niquet J Sharieff, G. & Hendry, P. (2011). Afebrile pediatric seizures. Emergency Medicine Clinics of North America. 29(1), 95-108. doi:10.1016/j.emc.2010.08.009 Stafstrom, C Vingerhoets, G. (2006). Cognitive effects of seizures. Seizure. 15(4), 221-226. doi:http://dx.doi.org.ezproxy.aut.ac.nz/10.1016/j.seizure.2006.02.012 Williams, J., Steel, C., Sharp, G., DelosReyes, E., Phillips, T., Bates, S., Lange, B Wilson, M., Macleod, S. & O’Regan, M. (2004). Nasal/buccal midazolam use in the community. Arch Dis Child. 89, 50-51. doi:10.1136/adc.2002.019836 Wiznitzer, M Admission to PICU Obtained from Nolan, Becca & Trenholme (2008)