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Peds Status Epilepticus

Liza Kearl, MD, Solomon Behar, MD, and Mizuho Morrison, DO
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Pediatric status epilepticus can be complex and challenging to manage. Every pediatric emergency department and pediatric critical care should have a hospital wide algorithm to help decrease errors and facilitate best patient practices. Liza Kearl MD, Sol Behar MD & Mizuho Spangler DO discuss a practical algorithmic approach in their ED.

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Paul Z. -

Why are you still recommending rectal diazepam? For home use, maybe (though our peds neurologists are even switching away from that), but we've all seen the kids who got rectal diastat at home and it didn't work. Why? It was in the poop! In our EDs, where anyone can give an immediately effective dose not only IV (which is challenging for those not used to kids) or IO (which not very small ED has) but also IM or intranasal - why do we even talk about PR anymore? When was the last ED shift when any of you used it? Time to get away from this dinosaur -- but it won't die as long as you keep recommending it!

Mizuho M., DO -

Agree with Sol. We never recommended it as first line tx or for acute care ED/ICU treatment. It was simply mentioned so that junior providers are aware that this might have been used prior to arrival and to prompt them to ask parents/EMS if it was given prior to arrival for calculating subsequent benzo dosing. Given our broad audience of listeners, completeness of medication routes is important for the sake of conversation.

Solomon B., MD -

Hi Paul- I don't think we were saying PR diazepam should be first line, but not every center has all the atomizers for IN meds and sometimes IV's are hard to start. IM is fine, agreed. But we were trying to lay out all the tools at the clinician's disposal for dealing with status. I think PR diazepam is actually a fine drug and regardless of how much poop is in there, if it makes contact with the rectal mucosa, it will get absorbed. Some seizures are just refractory to initial treatments! I used it last maybe a year ago on a kid we just could not get IV access on and the parent had it with them but was too scared to give it. It worked well!

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Nice Dermatitides Full episode audio for MD edition 159:42 min - 75 MB - M4AHippo Peds RAP February 2016 Summary 563 KB - PDF