Paediatric Status Epilepticus

Published 14/03/2024

Paediatric Status Epilepticus




2x 22G peripheral cannulas


Phenytoin infusion prepared by bedside (not connected)


Own, NRB on


Not required initially, Oxylog available by bedside


Paediatric airway trolley and equipment

CATS guidelines, intubation checklist and infusion calculator available on request (printed out)

Clinical Setting

I: You are the ICU registrar. The ED registrar bleeps you with a referral

S: There is a child in resus who has been admitted with tonic-clonic seizures

B: 6M with known epilepsy admitted following a tonic-clonic seizure at home (20 min ago). Further tonic-clonic seizure observed in resus by the registrar. He received diazepam with LAS and 1 dose IV lorazepam in ED

A: Drowsy, maintaining own airway but concerns given multiple seizures

R: 2 doses of benzodiazepine given so need additional support

Potential Clinical Course

  • Initially A own, B SpO2 100% on 15L O2, chest clear, C HR102 bpm, BP 98/54, D E1V2M5
  • Shortly after arrival patient has further seizure (3rd since admission)- appropriately starts phenytoin infusion/considers Keppra/status algorithm
  • Opens/supports airway/suctions
  • Gas provided when asked for:

pH 7.30, pO2 35.3, pCO2 4.5, Na 143, K 4.5, Lac 9, BE – 7.1

  • Asks for glucose (5.7)
  • Asks for temperature (37.9)
  • Gives fluid bolus +/- asks for antibiotics
  • Patient remains drowsy throughout scenario with no improvement in GCS. If prolonged deliberation can have further seizures



  • Calculates WETFLAG for patient
    • (Estimated weight should be 20kg) – if using age +4 x2
    • (Accept weight 25kg) – if using (age x3) +7
  • Calculates appropriate ETT size and distance, appropriate MAC blade
  • Calculates appropriate drug doses & plan for intubation
  • Ensures appropriate equipment available (ventilator, pumps, infusions)
  • Liaises with paediatric team/CATS & contacts ODP
  • Explains what is about to happen to family and informs senior
  • Considers organising septic screen/CXR/CT head
  • CATS call at the end of scenario asking for an update: please hand over


End of scenario (Scenario can also be terminated after calculations and explanations prior to proceeding to drug assisted intubation)

Info Sheet for Faculty

  • Initial settings:            SpO2 100% on 15L O2

                                         RR 24/min

                                         Bilateral breath sounds, no added sounds

                                         HR 110

                                         BP 92/54

                                         Groans when stimulated. Eyes closed, M5


  • Progress to:                Seizure activity 

                                         Dilated pupils

                                         Movement artefact on spO2 / HR                           


  • On seizure termination:  SpO2 100% pn 15L 02

                                              RR 20/min

                                              HR 98

                                              BP 89/49

                                              No verbal response, eyes closed, M4


Further observations depend upon actions.

Faculty Roles

ED nurse:

  • You are a senior ED nurse
  • The ED reg is busy with other patients and asked you to stay with this patient
  • This is a 6M with tonic clonic seizures (he has had 1 at home and 1 in resus) and has been given 2 doses of benzodiazepines (1 with LAS).
  • You are worried that this patient has continued to seize despite treatment
  • You sent initial blood tests to the lab when you cannulated (FBC, U&Es and CRP)
  • His parent is incredibly anxious, and you want the ICU doctor to reassure them
  • You take direction well, and can perform tasks asked if you in a timely fashion, you just lack impetus
  • If the candidate asks for the on-call ODP say that you’ve called, and they are on the way but that you can help them get any equipment needed



  • You are worried about your son, his epilepsy is usually very well-controlled.
  • You want to know what is going on and when he can go home.
  • You are worried this is your fault because he’s not been himself these last few days and you just thought he had a cold.
  • You are not disruptive but refuse to leave your sons bedside and hold his hand throughout. When he has a seizure, you get very upset and distressed.
  • If you hear the doctor discussing intubation you get very worried. He has never been intubated/been to ICU before, and you don’t know what this means. You just want an explanation and if you get one you are amenable.