Emergency Department Clinical Pathway for
Management of New Unprovoked Seizure(s)
Related Pathways
- Abuse Physical, ED
- EEG Monitoring, PICU, NICU, CICU
- Febrile Seizures, ED and Inpatient
- Head Trauma, Acute, ED
- Intracranial Hypertension, Non-Traumatic, All Settings
- Meningitis, Suspected, ED, Inpatient, ICU
- Status Epilepticus, ED
- Stroke, ED
- Traumatic Brain Injury, ED and ICU
- Ventricular Shunt Obstruction/Infection, ED, ICU, Inpatient
- FLOC/RN Assessment
- VS, mental status, neurologic exam
- History, physical exam
- Consider POC glucose if altered mental status
Concern for Provoked Seizure
or Status Epilepticus
or Status Epilepticus
- Evaluation, treatment as clinically indicated
- Neurology Consultation
- Evaluate for Concerning Features
- Mental status not improving after 15 minutes from seizure cessation or ED presentation
- Post-seizure (Todd’s) paralysis lasting > 15 minutes
- Seizure duration > 5 minutes
- Medication used to stop seizure
- > 1 seizure in 24 hours
- Focal seizure
- Developmental regression
- Age < 2 years
- Anticipated difficulty with Neurology follow up
No Concerning Feature(s) Present
Concerning Feature(s) Present
- Patient returned to baseline mental status and exam
- Emergent Imaging and Labs not generally indicated
- Evaluation considerations
- Imaging, Labs, EEG
- Neurology consultation
Discharge
Consider Discharge
Return to baseline mental status and exam
Return to baseline mental status and exam
Consider Admission
Persistently altered mental status and/or abnormal neurologic exam
Persistently altered mental status and/or abnormal neurologic exam
- Neurology follow up within 2 weeks
- Review seizure discharge instructions
- ED Provider:
- Orders Neurology follow-up appointment in EPIC
- Consider rescue medication if:
- Seizure > 5 min
- Lives far from medical care
- Review seizure discharge instructions
- Neurology arranges:
- EEG with appointment
- MRI
- Expedited within 1 week or
- Routine within 2-4 weeks
- Need for Urgent MRI (< 48 hrs)
- ED places MRI order, if indicated
- Anticipated difficulty with Neurology follow up
Posted: April 2021
Authors: L. Buchhalter, MD; M. Blackstone, MD; N. Abend, MD; P. Joshi, MD; A. Patel, CRNP; L. Wilson, RN;
M. Pinardo, RN, E. Schwartz, MD, J. Tencer, MD
Authors: L. Buchhalter, MD; M. Blackstone, MD; N. Abend, MD; P. Joshi, MD; A. Patel, CRNP; L. Wilson, RN;
M. Pinardo, RN, E. Schwartz, MD, J. Tencer, MD
Evidence
- Practice Parameter: Evaluating a First Nonfebrile Seizure in Children
- The Role of Emergent Neuroimaging in Children with New-Onset Afebrile Seizures
- The Role of Brain Computed Tomography in Evaluating Children with New Onset of Seizures in the Emergency Department
- Utility of Laboratory Testing for Infants with Seizures
- Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures
- Utility of Obtaining a Serum Basic Metabolic Panel in the Setting of a First-Time Nonfebrile Seizure
- Diagnostic Value of Lumbar Puncture in Afebrile Infants with Suspected New-Onset Seizures
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