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ER Management of Status Epilepticus in Children
Prompt and effective management of status epilepticus in children is critical to prevent neurological complications and long-term sequelae. Initial management involves ensuring the child's safety and stabilizing vital signs, followed by rapid administration of antiepileptic medications. Benzodiazepines such as lorazepam or midazolam are first-line agents for terminating seizures and preventing progression to status epilepticus. If seizures persist, second-line agents such as phenytoin, fosphenytoin, or levetiracetam may be administered intravenously to achieve seizure control. In refractory cases, continuous infusions of anesthetic agents such as midazolam or propofol may be initiated in the intensive care unit. Timely neuroimaging studies may be indicated to rule out structural abnormalities or identify potential reversible causes of status epilepticus.
About the Speaker
Dr. Col Om Prakash Singh
Professor & HOD Pediatrics Narayana Medical College, Patna
Dr. Om Prakash Singh is currently working as Professor & HOD Pediatrics in Narayana Medical College,Patna. He has 21 years of experience and 10+ yrs as Professor in Pediatrics. He has 27 publications across India. He is a life member of Indian Pediatric Association (IAP) & National Neonatal Forum ( NNF).
Upcoming Case Discussions
Management of Neuropathic Pain
Diabetic polyneuropathy is a common complication of diabetes mellitus, characterized by nerve damage throughout the body due to prolonged high blood sugar levels. Symptoms can vary widely, including numbness, tingling, burning pain, weakness, and loss of sensation, typically starting in the feet and gradually spreading to other areas. Diagnosis involves a thorough medical history, neurological examination, and nerve conduction studies. Management focuses on glycemic control through medications, lifestyle modifications, and pain management strategies such as analgesics, anticonvulsants, and antidepressants. Additionally, addressing risk factors such as smoking, hypertension, and dyslipidemia is crucial. Regular monitoring for complications such as foot ulcers and autonomic dysfunction is essential for preventing further nerve damage and improving quality of life.
H. pylori Treatment with PYELRA®: Best Practices
PYLERA® is a medication used for the treatment of Helicobacter pylori (H. pylori) infection, a common cause of stomach ulcers and gastritis. It contains a combination of three active ingredients: bismuth subcitrate potassium, metronidazole, and tetracycline. This combination works synergistically to eradicate H. pylori bacteria and reduce associated symptoms. Treatment with PYLERA® typically involves taking multiple capsules four times a day for a specified duration, as prescribed by a healthcare provider. It is important to follow the treatment regimen as directed and to discuss potential side effects
Iron Deficiency Anemia in Pediatrics
Iron deficiency anemia in pediatrics is a common condition characterized by insufficient iron levels, leading to decreased hemoglobin production and reduced oxygen-carrying capacity of the blood. It typically presents with symptoms such as fatigue, pallor, irritability, and poor feeding. Risk factors include premature birth, low birth weight, inadequate dietary intake, and rapid growth periods. Diagnosis is confirmed through laboratory tests showing low hemoglobin, hematocrit, and serum ferritin levels. Management involves dietary modifications to increase iron-rich foods, and iron supplementation with close monitoring of hematologic response and potential side effects such as gastrointestinal discomfort. Early detection and treatment are crucial to prevent cognitive and developmental delays.
Hypertension Management & Treatment Algorithms
Ventilator-associated pneumonia (VAP) is a serious and potentially life-threatening infection that occurs in patients who are mechanically ventilated in hospitals or intensive care units (ICUs). It arises due to the colonization of the lower respiratory tract by pathogens, often through contaminated equipment or aspiration of oral or gastric secretions. VAP is associated with prolonged hospital stays, increased morbidity and mortality rates, and significant healthcare costs. Prevention strategies include meticulous oral hygiene, elevation of the head of the bed, regular ventilator circuit changes, and judicious use of antibiotics. Diagnosis of VAP involves clinical criteria, such as new or progressive pulmonary infiltrates, along with microbiological confirmation through bronchoalveolar lavage or endotracheal aspirate cultures. Implementation of evidence-based bundles and protocols can standardize care practices and reduce the risk of VAP in critically ill patients. Despite advancements in prevention and management strategies, VAP remains a significant challenge in critical care settings, underscoring the importance of ongoing research and vigilance in combating this healthcare-associated infection.
Paraquat Poisoning
Paraquat poisoning is a medical emergency resulting from exposure to paraquat, a potent and highly toxic herbicide commonly used in agriculture. The poison can enter the body through ingestion, inhalation, or skin contact, and even small amounts can be lethal. Once absorbed, paraquat generates reactive oxygen species that cause extensive cellular damage, particularly in the lungs, liver, and kidneys. Initial symptoms of paraquat poisoning include severe abdominal pain, nausea, vomiting, and diarrhea, often with blood. As the condition progresses, it leads to respiratory distress, acute kidney injury, liver failure, and potentially fatal pulmonary fibrosis. Inhalation can cause severe lung damage, while skin contact may lead to burns and systemic toxicity if not promptly treated.Diagnosis is primarily based on the history of exposure and clinical symptoms, supported by laboratory tests that detect paraquat in blood or urine. Unfortunately, there is no specific antidote for paraquat poisoning. Treatment focuses on reducing further absorption of the toxin—typically through gastric lavage, activated charcoal, or Fuller's earth—and supportive care to manage symptoms and complications. This may include oxygen therapy, dialysis for kidney failure, and other intensive care measures.Due to its extreme toxicity and the lack of effective treatments, paraquat use is highly restricted and banned in many countries. In regions where it is still used, strict safety protocols are enforced to minimize the risk of exposure.
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Dr. Col Om Prakash Singh's Talks on Assimilate
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Prompt and effective management of status epilepticus in children is critical to prevent neurological complications and long-term sequelae. Initial management involves ensuring the child's safety and stabilizing vital signs, followed by rapid administration of antiepileptic medications. Benzodiazepines such as lorazepam or midazolam are first-line agents for terminating seizures and preventing progression to status epilepticus. If seizures persist, second-line agents such as phenytoin, fosphenytoin, or levetiracetam may be administered intravenously to achieve seizure control. In refractory cases, continuous infusions of anesthetic agents such as midazolam or propofol may be initiated in the intensive care unit. Timely neuroimaging studies may be indicated to rule out structural abnormalities or identify potential reversible causes of status epilepticus.