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Management of Pediatric Medical Emergencies in the Dental Office

Course Number: 391

Petit Mal and Absence Seizures

Petit mal seizures occur in 25% of all epilepsy patients and 5% of pediatric epilepsy patients (are most common between ages 3-15 years). They occur frequently (multiple daily episodes) usually shortly after awakening or during periods of inactivity.

The clinical manifestations are:

  • Unresponsiveness

  • Eyelid clonus (rapid or cyclic blinking)

  • Tonic or atonic features

  • If standing, the patient will remain standing

  • There is no aura or postictal state

  • The duration does not exceed 10 seconds

Emergency Management

Management of petit mal seizure and absence seizures is to protect the victim from injury. Even with no assistance from staff there is little or no danger of death to the victim. Most seizures last from five seconds to two minutes. Should a seizure last longer than this, the following steps should be taken:

  1. Recognize the problem based on the patient’s medical history.

  2. Recognize the problem (lack of response to stimulation).

  3. Discontinue dental treatment.

  4. Activate the office emergency team.

  5. If the patient is standing allow them to continue to do so. If positioned supine in the dental chair do not change the position except to elevate the feet.

  6. Once the seizure ceases (<5 minutes) reassure the patient.

  7. Discharge patient once fully recovered with a responsible adult.

If the seizure lasts more than 5 minutes:

  1. Activate EMS.

  2. Perform BLS as needed.

  3. If intravenous (IV) access is available administer diazepam (Valium) IV:

    • Child up 5 years 0.2-0.5 mg slowly every 2-5 minutes with a maximum of 5mg.

    • Child up to 5 years and up 1 mg every 2-5 minutes with a maximum of 10 mg.