Tratamento da convulsão na pediatria - Dr Caique Acácio

Summary

The transcript provides an in-depth guide on how to manage pediatric seizures in emergency situations. It covers initial treatment steps such as monitoring the patient, administering oxygen, and managing blood glucose levels. The use of benzodiazepines like diazepam and midazolam is emphasized, offering tips on how to administer these drugs intramuscularly or nasally, especially when venous access is difficult. For cases that don’t respond to initial treatment, the script introduces additional medications like phenytoin and phenobarbital, as well as the potential need for sedation and continuous infusion therapies in more severe cases.

Takeaways

• 😀 **Patient Monitoring is Key**: When a patient is seizing, the first priority is to monitor vital signs, provide oxygen, and establish intravenous access for potential medications.
• 😀 **Initial Actions for Seizures**: In the first 5 minutes, focus on life-saving measures (oxygen, glucose, and monitoring) before considering medications if the seizure persists.
• 😀 **Assess Glucose Levels**: Seizures can often be caused by hypoglycemia, so it's crucial to check blood glucose levels and administer glucose if needed to prevent further complications.
• 😀 **Positioning the Airway**: Ensure that the airway is clear by positioning the head, extending the neck, and moving the jaw forward to prevent aspiration during a seizure.
• 😀 **Use of Benzodiazepines**: The first-line treatment for seizures is benzodiazepines like diazepam and midazolam, administered every 5 minutes if the seizure continues.
• 😀 **Intramuscular Administration of Diazepam**: If intravenous access is difficult, diazepam can be given intramuscularly, though midazolam is often preferred as it’s easier to administer.
• 😀 **Midazolam for Seizures**: Midazolam is effective and simple to administer intramuscularly, with a recommended dose based on the patient’s weight, avoiding the complexities of calculating exact dosages for intravenous administration.
• 😀 **Calculate Dosages Efficiently**: For midazolam and diazepam, an easy rule of thumb is to multiply the patient’s weight by a specific factor (0.04 for midazolam, 0.06 for diazepam) to determine the required dose.
• 😀 **Managing Refractory Seizures**: If the seizure persists despite benzodiazepine use, further treatments like phenytoin or phenobarbital may be necessary, with careful monitoring for adverse effects like arrhythmias.
• 😀 **Continuous Infusion for Severe Cases**: For cases where seizures do not resolve, continuous infusion of midazolam or other sedative agents (e.g., propofol) should be considered, calculated using a specific formula based on the patient’s weight and dosage required.
• 😀 **Sedation and Intubation**: In extreme cases, if the seizures do not stop, sedation and intubation may be required to protect the airway and ensure adequate oxygenation.

Q & A

What is the initial approach when dealing with a patient experiencing a seizure?

The first step is not to immediately administer medication. Instead, focus on monitoring the patient’s vital signs, ensuring adequate oxygen supply, and maintaining an open airway. This helps stabilize the patient before considering medication.

Why is oxygen administration important for a patient having a seizure?

During a seizure, the brain consumes a lot of energy and oxygen, which can lead to a drop in oxygen saturation levels. Administering oxygen helps prevent hypoxia and ensures the patient’s survival.

What should be done if a patient continues to have seizures after five minutes?

If the seizures continue after five minutes, medication should be administered. Benzodiazepines, such as diazepam or midazolam, are the first-line treatment to stop the seizure activity.

What role does glucose play in managing seizures?

Hypoglycemia (low blood sugar) can trigger seizures. Therefore, it is important to check the patient's blood glucose levels. If low, administering glucose can stop the seizure, potentially saving the patient's life.

Why is midazolam considered easier to administer than diazepam for seizures?

Midazolam is easier to administer because it can be given intramuscularly without dilution, whereas diazepam is often difficult to absorb when given intramuscularly, making midazolam the preferred option when access to a vein is challenging.

How should diazepam be administered if intravenous access is not available?

Diazepam can be administered intranasally or rectally if intravenous access is not available. Nasal administration requires a specific device, while rectal administration uses a catheter or syringe.

What is the recommended dosage of midazolam for seizure management?

The recommended dosage of midazolam is 0.04 mg per kilogram of body weight, administered either intramuscularly or intranasally, depending on the situation.

What should be done if a seizure does not stop after initial doses of benzodiazepines?

If the seizure does not stop after the initial doses of benzodiazepines, the next step is to administer phenytoin. If the patient is younger than three months, phenobarbital may be used instead.

What is the protocol for administering phenytoin during a seizure?

Phenytoin should be administered in an initial dose of 20 mg/kg, diluted and infused slowly over 20 minutes. If the seizure continues, a second dose of 10 mg/kg can be given after 15 minutes.

How is the dosing for continuous infusion of midazolam calculated?

The continuous infusion of midazolam is calculated using the formula: (Patient weight in kg) x (Desired dose in mg/kg) x (Time in hours) ÷ (Concentration of the drug). The resulting volume is then diluted in saline and administered through an infusion pump over 24 hours.