Management of Pediatric Medical Emergencies in the Dental Office
Grand mal Status Epilepticus

Status epilepticus is defined as a continuous seizure or a repetitive recurrence of any type of seizure without recovery between attacks. It is life threatening. Patients in status epilepticus exhibit the same clinical signs and symptoms as those in the convulsive phase of tonic-clonic seizure. The major difference is while a tonic clonic seizure may last 2 to 5 minutes, status epilepticus may last for hours or days and may lead to death.

The clinical manifestations are:

• Any clonic-tonic seizure lasting more than 5 minutes
• Nonresponsiveness or unconsciousness
• Cyanotic, diaphoretic
• Generalized clonic contractions with brief or absent tonic phase
• Elevated body temperature (41°C, 106°F)
• Tachycardia and dysrhythmias
• Elevated blood pressure

Unterminated status epilepticus may lead to the following:

• Death as a result of cardiac arrest
• Irreversible neuronal damage from cerebral hypoxia
• A decrease in cerebral blood flow in response to increased intracranial pressure
• A significant decrease in blood glucose levels as the brain uses large amounts for metabolism

Management

Management of status epilepticus follows the same protocol as grand mal seizure (see Grand mal Seizures). However if the seizure continues beyond 5 minutes activate emergency services and if the office staff is properly trained administer intravenous anticonvulsive drugs. Assess and perform basic life support until emergency medical support with advanced training arrives.¹⁰