ED - Simple and Complex Febrile Seizures (3 mos - 6 years)
Last Updated: 7/12/2016 7:25:11 PM
Order Set
  Associated Pathway(s)
 Simple and Complex Febrile Seizures (6 mos - 5 years) - http://www.curbsideup.com/link/1205
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  Inclusion Criteria
Inclusion Criteria ( All criteria are present )
  • ≥ 1 seizure accompanied by fever (T >/= 38C) or parental report of fever within 24 hours
Exclusion Criteria
  • Toxic appearing
  • Previous afebrile seizure
  • Oncologic patient or Immunodeficiency
  • Trauma
  • VP shunt, previous neurosurgery, structural brain abnormality or intracranial mass
  • Ingestion
  • Developmental delay, complex genetic or metabolic disorder or any other history making a full neurologic exam complex
  General
  Monitoring
Weight
ONCE
Vitals signs
Per protocol
  Diet
Diet NPO
Continuous
  Respiratory Therapy
  Supplemental Oxygen
Nursing communication
Begin supplemental oxygen therapy for persistent oxygen saturation below 90% awake, 88% asleep or severe respiratory distress.
Pulse Oximetry/O2 Sats
STAT, CONTINUOUS, Indication: When patient is on supplemental oxygen
  Medications
  Does patient have any contraindications to acetaminophen?
      Allergy or hypersensitivity, hepatic impairment, severe hypovolemia, PKU or other liver disease, chronic malnutrition
No
Acetaminophen (TYLENOL) oral solution 15 mg/kg (Dosing Weight)
15 mg/kg, Oral, EVERY 4 HOURS PRN, Pain mild, Temp > 38.5 C, (max 650mg)
Acetaminophen (TYLENOL) tablet 650 mg
650 mg, Oral, Every 4 HOURS PRN, Pain mild, Temp > 38.5 C
  Does patient have any contraindications to ibuprofen?
      Allergy or hypersensitivity, G6PD, renal impairment, severe hypovolemia, bleeding or coagulation disorder, gastritis or PUD, long bone fracture
No
Ibuprofen (MOTRIN) oral solution 10 mg/kg (Dosing Weight)
10 mg/kg, Oral, EVERY 6 HOURS, PRN, Pain mild, Temp > 38.5 C
Ibuprofen (MOTRIN) tablet 200 mg
600 mg, Oral, EVERY 6 HOURS, PRN, Pain mild, Temp > 38.5 C
  Does patient have any contraindications to ondansteron?
      Allergy or hypersensitivity, long QT disorders
No
Ondansteron (Zofran ODT) ODT 4mg
4 mg PO, EVERY 8 HOURS, PRN, nausea, vomiting
Ondansteron (Zofran) 0.15 PEDIATRIC IV infusion
0.15 mg/kg IV, EVERY 8 HOURS, PRN, nausea, vomiting
  Concern for meningitis or encephalitis?
  • 6-12 mos old and incomplete immunization status for HiB or Strep pneumo
  • Pretreated with abx
  • Persistent altered mental status
  • Nuchal rigidity
  • Petechia
  • Bulging fontanelle
  Labs
CSF culture
CSF, One time
CSF glucose and protine
CSF, One time
CSF cell count
CSF, One time
CBC with Differential
Lab, One time
Complete metabolic panel
Lab, One time
Blood Culture (Aerobic & Anaerobic Bottles)
Lab, One time
CSF enterovirus PCR
Lab, One time
  Actively seizing patients
  IV access
Nursing communication
Please obtain IV access
  Has the patient received rescue anti-epileptics during this seizure?
Yes
Fosphenytoin IV
20 mg/kg, IV, Once
Levetiracetam IV
50 mg/kg, IV, Once
No
Lorazepam IV
0.1 mg/kg, IV, Once, May repeat x1 if continued seizure activity after 5 minutes
Midazolam Intranasal
0.2 mg/kg, Intranasal, Once, May repeat x1 if continued seizure activity after 5 minutes
  Complex febrile seizure

Concern for complex febrile seizure if any of the following are present

  • < 15 minutes long
  • No recurrence within 24 hours
  • Generalized (no focal onset or features of seizure)
  • Return to baseline with no residual focal neurologic deficits
  Does the patient remain altered or obtunded after seizure?
Yes
Blood glucose POC
Lab one time
Complete metabolic panel
Lab one time
Serum calcium
Lab one time
Serum phosphorus
Lab one time
Serum magnesium
Lab one time
Ammonia
Lab one time
Complete blood count
Lab one time
Urinalysis
Lab one time
Urine toxicology screen
Lab one time
  Does the patient have a persistent focal neurological deficit?
Yes
Head CT
Indication: concern for intracranial mass, bleed or other process
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