Febrile Convulsion / Paediatric Status Epilepticus

Febrile convulsions affect 3% of children aged 6 months–5 years. Simple febrile convulsions are self-limiting (<15 min, generalised, single episode). Prolonged or complex seizures require active treatment with benzodiazepines and urgent…

APLS Seizure Protocol

The pathway

1 · Recognise & time

Note time of seizure onset. Position safely (lateral, airway), do not restrain. Call for help immediately.

2 · Airway & O₂

High-flow O₂ via mask. Suction if necessary. Recovery position post-ictally.

3 · 5 minutes — first benzodiazepine

Buccal midazolam 0.3mg/kg (max 10mg) if no IV access. OR IV/IO lorazepam 0.1mg/kg if access available.

4 · 10 minutes — second benzodiazepine

If still seizing: repeat buccal midazolam OR IV lorazepam. IV access should now be established.

5 · 25 minutes — second-line agent

IV phenobarbital 20mg/kg over 20 min (or levetiracetam 40mg/kg IV if preferred). Anaesthetics present.

6 · Exclude meningitis

Post-ictally: assess for meningism, rash, fontanelle. LP if suspected. Treat with IV ceftriaxone if in doubt.

Drugs

Drug	Dose	Route	Notes
Midazolam (buccal)	0.3mg/kg	Buccal	Max 10mg. First-line if no IV access. Give between gum and cheek.
Lorazepam	0.1mg/kg	IV/IO	Max 4mg per dose. Two doses max. Give slowly over 1–2 min.
Phenobarbital	20mg/kg	IV	Infuse over 20 minutes. Monitor BP. Anaesthetics on standby.
Levetiracetam	40mg/kg	IV	Max 3g. Alternative second-line. Fewer sedation side effects.
Paracetamol	15mg/kg	PO/PR	For fever. Does not prevent further seizures but improves comfort.

When to escalate

Status epilepticus (>5 min or no response to first benzo) — call PICU / paediatric registrar,Non-blanching rash — meningococcal disease, IV ceftriaxone immediately,Persistent altered consciousness post-ictally — urgent CT/LP, neurology,Age <6 months or >5 years — not typical febrile convulsion, investigate further

Reference: APLS Advanced Paediatric Life Support / NICE NG217 Epilepsies (replaced CG137)

This page is the reference half

The app adds what a web page cannot: a VINDICATE differential builder, worked on-call scenarios with full A–E findings, recall practice, and all of it offline.