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User can click on icon to access the healthcare worker resources page.",{"edges":549},[550,553,556,558,561,564,567,570,573,575,578,581,584,587,589,591,593,595,597,600,603,606,609,611,613,615,618,620,623,626,628,630,632,635,638,640,643,646,648,650,653,656,659,662,665,667,669,671],{"node":551},{"name":552},"Procedural Anxiety and Fear",{"node":554},{"name":555},"Measles",{"node":557},{"name":172},{"node":559},{"name":560},"Agitation",{"node":562},{"name":563},"Anxiety",{"node":565},{"name":566},"Iron Deficiency Anemia",{"node":568},{"name":569},"Influenza",{"node":571},{"name":572},"Advanced Life Support",{"node":574},{"name":53},{"node":576},{"name":577},"Migraine",{"node":579},{"name":580},"Abdominal Pain",{"node":582},{"name":583},"Pneumonia (Community Acquired)",{"node":585},{"name":586},"Chronic Pain",{"node":588},{"name":61},{"node":590},{"name":69},{"node":592},{"name":76},{"node":594},{"name":83},{"node":596},{"name":90},{"node":598},{"name":599},"COVID-19",{"node":601},{"name":602},"Cannabis",{"node":604},{"name":605},"Developmental and Intellectual Disabilities",{"node":607},{"name":608},"Child Abuse",{"node":610},{"name":97},{"node":612},{"name":104},{"node":614},{"name":111},{"node":616},{"name":617},"Critically Ill Neonate",{"node":619},{"name":119},{"node":621},{"name":622},"Eating Disorders",{"node":624},{"name":625},"Febrile Seizures",{"node":627},{"name":126},{"node":629},{"name":133},{"node":631},{"name":141},{"node":633},{"name":634},"Hand Foot and Mouth",{"node":636},{"name":637},"High Flow Nasal Cannula",{"node":639},{"name":148},{"node":641},{"name":642},"Meningitis",{"node":644},{"name":645},"Mental Health Self Assessment Tool",{"node":647},{"name":156},{"node":649},{"name":164},{"node":651},{"name":652},"Procedural Pain",{"node":654},{"name":655},"Procedural Sedation",{"node":657},{"name":658},"Sepsis",{"node":660},{"name":661},"Severe Head Injury",{"node":663},{"name":664},"Sickle Cell Disease",{"node":666},{"name":180},{"node":668},{"name":188},{"node":670},{"name":196},{"node":672},{"name":673},"Visiting the Emergency Department",{"debug":675,"queryAnalyzer":676},[],{"keys":677,"keysLength":678,"keysCount":679,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":682},"6d6b3d1b2eca580f2aae3985d71dc00ef8fba31240f69e3257cf81d43dbf639a graphql:Query list:menuitem list:audience list:topic cG9zdDoxODY4 cG9zdDo0ODU5 cG9zdDoxNjQ= cG9zdDo5NDc= cG9zdDoxNjA= cG9zdDo0NzAz cG9zdDoxNjE= cG9zdDoxNjM= cG9zdDoyMDE= cG9zdDoyMDI= cG9zdDoyMDM= cG9zdDoyMDU= cG9zdDoyMDY= cG9zdDoyMDg= cG9zdDoyNzkx cG9zdDoyMDk= cG9zdDoyMTA= cG9zdDoyNzky cG9zdDoyMTE= cG9zdDoyNzk2 cG9zdDoyNzkz cG9zdDo0NzA0 cG9zdDoyNzk3 cG9zdDoyNzk0 cG9zdDoyNzk1 cG9zdDoxOTE= cG9zdDoxOTI= cG9zdDoxOTY= cG9zdDoxOTU= cG9zdDoxOTQ= cG9zdDoxOTM= cG9zdDoxMjY= cG9zdDoxMjU= cG9zdDoxOTc= cG9zdDoxOTg= cG9zdDoxOTk= cG9zdDoyMDA= dGVybToxMDg= dGVybToyMA== dGVybTo0ODE= dGVybTo0NzY= dGVybTo0Njk= dGVybTo0NDc= dGVybTo0NTQ= dGVybTo0NTg= dGVybTo0NjE= dGVybTo0NjM= dGVybTo0NjQ= dGVybTo0NzE= dGVybTo0NzI= dGVybTo0MzI= dGVybTo0MzQ= dGVybToyMg== dGVybToyNQ== dGVybToyNw== dGVybToyOA== dGVybTozMA== dGVybTozNQ== dGVybTozMQ== dGVybTozMg== dGVybTo1OQ== dGVybTozMw== dGVybTozNA== dGVybTozNw== dGVybTozNg== dGVybTozOA== dGVybTo0MjE= dGVybToxMTQ= dGVybTo0MA== dGVybTo0MQ== dGVybTo0Mg== dGVybTo2MQ== dGVybToxMTA= dGVybTo0NA== dGVybTo0Ng== dGVybToxMDU= dGVybTo0Nw== dGVybTo0OA== dGVybTo1MQ== dGVybTo1Mg== dGVybTo1NA== dGVybTo1NQ== dGVybTo1Ng== dGVybTo1Nw== dGVybTo1OA== dGVybTo2MA== dGVybToxMDM= cG9zdDoyMzc3 cG9zdDoyMzc1",1274,94,"",0,[],{"data":684,"extensions":1051},{"topics":685},{"edges":686},[687,696,702,709,717,725,733,739,745,751,759,765,773,778,786,794,802,810,818,825,833,841,849,857,865,873,881,889,897,905,913,921,928,936,943,951,959,967,974,981,989,997,1005,1013,1021,1028,1035,1043],{"cursor":688,"node":689},"YXJyYXljb25uZWN0aW9uOjQ4MQ==",{"name":552,"slug":690,"description":691,"translations":692},"procedural-fear-and-anxiety","Anxiety and fears about medical procedures are common in children/youth: two-thirds report needle fear and 10% report needle phobia. Addressing this anxiety/fear is critical, as up to half of children seen in the Emergency Department undergo painful procedures (e.g., IVs, blood tests, catheterizations, wound repair). Procedural pain is complex, involving both physical pain and anxiety/fear. Inadequate management of either increases future anxiety and can lead to healthcare avoidance that persists into adulthood. Managing both improves procedural success and optimizes future care. ",[693],{"languageCode":694,"slug":695},"fr","peur-et-anxiete-procedurale",{"cursor":697,"node":698},"YXJyYXljb25uZWN0aW9uOjQ3Ng==",{"name":555,"slug":699,"description":700,"translations":701},"measles","Measles is a single stranded, enveloped RNA virus belonging to the Morbillivirus genus in the Paramyxoviridae family. The virus can cause a measles infection which starts in the respiratory epithelium of the nasopharynx. Measles is highly contagious.\r\n\r\nMore information coming soon. ",[],{"cursor":703,"node":704},"YXJyYXljb25uZWN0aW9uOjQ2OQ==",{"name":172,"slug":705,"description":171,"translations":706},"respiratory-distress",[707],{"languageCode":694,"slug":708},"detresse-respiratoire-fr",{"cursor":710,"node":711},"YXJyYXljb25uZWN0aW9uOjQ0Nw==",{"name":560,"slug":712,"description":713,"translations":714},"agitation","A clinical tool to guide decision-making when caring for agitated pediatric patients in emergency settings.",[715],{"languageCode":694,"slug":716},"prise-en-charge-du-patient-agite",{"cursor":718,"node":719},"YXJyYXljb25uZWN0aW9uOjQ1NA==",{"name":563,"slug":720,"description":721,"translations":722},"anxiety","Anxiety is a normal emotional and physiological response to uncomfortable, novel or frightening situations. During an emergency department (ED) visit, anxiety can be experienced by any child or adolescent as well as by their caregivers. It may be the primary reason for the visit or develop during assessments, procedures, or investigations. \r\nHow individuals experience anxiety during an ED visit can vary. Approaches to recognize, assess and manage anxiety need to be patient- and family-centred.\r\n",[723],{"languageCode":694,"slug":724},"anxiete",{"cursor":726,"node":727},"YXJyYXljb25uZWN0aW9uOjQ1OA==",{"name":566,"slug":728,"description":729,"translations":730},"iron-deficiency-anemia","Iron deficiency anemia (IDA) is most commonly found in toddlers and adolescents. A primary diagnosis should be identified to explain insufficient intake or excessive loss of iron. The treatment for IDA is supplemental iron. Blood transfusion is restricted to emergency management of patients with hemodynamic instability. ",[731],{"languageCode":694,"slug":732},"iron-deficiency-anemia-fr",{"cursor":734,"node":735},"YXJyYXljb25uZWN0aW9uOjQ2MQ==",{"name":569,"slug":736,"description":737,"translations":738},"influenza","Resources to support informed decision-making in the care of pediatric patients with influenza in emergency settings.",[],{"cursor":740,"node":741},"YXJyYXljb25uZWN0aW9uOjQ2Mw==",{"name":572,"slug":742,"description":743,"translations":744},"advanced-life-support","Pediatric Advanced Life Support (PALS) is a set of clinical guidelines and techniques used to provide emergency care to infants and children experiencing life-threatening medical conditions, such as cardiac arrest, respiratory failure, or shock. It focuses on rapid assessment, early intervention, and the use of advanced airway management, medications, and defibrillation to stabilize and resuscitate pediatric patients. ",[],{"cursor":746,"node":747},"YXJyYXljb25uZWN0aW9uOjQ2NA==",{"name":53,"slug":748,"description":749,"translations":750},"education-session","The tool provides access to all the  TREKK and University of Manitoba's virtual education session videos.",[],{"cursor":752,"node":753},"YXJyYXljb25uZWN0aW9uOjQ3MQ==",{"name":577,"slug":754,"description":755,"translations":756},"migraine","Migraine accounts for up to 30% of pediatric Emergency Department (ED) visits for headache and results in frequent ED revisits. The average age of onset is 7 years in boys and 9 years in girls. Migraine is more common in girls by adolescence. Evidence for ED management of acute migraine attacks in children and adolescents is limited, resulting in significant practice variation.",[757],{"languageCode":694,"slug":758},"migraine-fr",{"cursor":760,"node":761},"YXJyYXljb25uZWN0aW9uOjQ3Mg==",{"name":580,"slug":762,"description":763,"translations":764},"abdominal-pain","Abdominal pain is a common complaint in children, often leading to visits to the emergency department (ED). It can be caused by various conditions, ranging from mild issues like constipation or gas to more serious concerns such as infections or gastrointestinal conditions. Children may experience abdominal pain differently, with younger children having difficulty describing their discomfort. Recognizing, assessing, and managing abdominal pain requires a patient- and family-centred approach to address both the physical and emotional aspects of care.",[],{"cursor":766,"node":767},"YXJyYXljb25uZWN0aW9uOjQzMg==",{"name":583,"slug":768,"description":769,"translations":770},"pneumonia","Viruses are the leading cause of pneumonia in healthy young children, followed by bacteria and rarely, other organisms. These resources focus on uncomplicated community acquired pneumonia (CAP).",[771],{"languageCode":694,"slug":772},"pneumonie",{"cursor":774,"node":775},"YXJyYXljb25uZWN0aW9uOjQzNA==",{"name":586,"slug":776,"description":14,"translations":777},"chronic-pain",[],{"cursor":779,"node":780},"YXJyYXljb25uZWN0aW9uOjIy",{"name":61,"slug":781,"description":782,"translations":783},"aom","Acute Otitis Media (AOM) is common in children under 5 years of age and is often a self-limited illness lasting several days. The mainstay of AOM management is symptom/pain control. In some cases, AOM can be more prolonged or severe and requires antibiotic treatment.",[784],{"languageCode":694,"slug":785},"aom-fr",{"cursor":787,"node":788},"YXJyYXljb25uZWN0aW9uOjI1",{"name":69,"slug":789,"description":790,"translations":791},"anaphylaxis","Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can be fatal. The highest incidence of anaphylaxis is in children and youth. The three principal triggers of anaphylaxis are foods, insect stings, and drugs. In Canada, there is an Emergency Department (ED) visit for food allergy approximately every 10 minutes, and up to 80% of anaphylactic reactions in children are triggered by foods such as peanuts, tree nuts, and milk.",[792],{"languageCode":694,"slug":793},"anaphylaxis-fr",{"cursor":795,"node":796},"YXJyYXljb25uZWN0aW9uOjI3",{"name":76,"slug":797,"description":798,"translations":799},"asthma","Approximately one-third of children with asthma presenting to the emergency department (ED) have moderate respiratory distress, and less than 5% will have a severe exacerbation. There are some differences between provincial asthma pathways with regards to PRAM scores and treatment. ",[800],{"languageCode":694,"slug":801},"asthme",{"cursor":803,"node":804},"YXJyYXljb25uZWN0aW9uOjI4",{"name":83,"slug":805,"description":806,"translations":807},"bronchiolitis","Bronchiolitis is a common viral illness. It is most commonly caused by respiratory syncytial virus and typically occurs over the late fall and winter months. Children less than 2 years of age are most commonly affected, with the largest burden of illness being in children less than 12 months of age.",[808],{"languageCode":694,"slug":809},"bronchiolitis-fr",{"cursor":811,"node":812},"YXJyYXljb25uZWN0aW9uOjMw",{"name":90,"slug":813,"description":814,"translations":815},"burns","Burns are a leading cause of unintentional injury and death in children, with the vast majority of cases occurring in the home. Regardless of the burn depth or extent, these injuries can have significant long-term functional, aesthetic, and psychological consequences for the child.",[816],{"languageCode":694,"slug":817},"burns-fr",{"cursor":819,"node":820},"YXJyYXljb25uZWN0aW9uOjM1",{"name":599,"slug":821,"description":14,"translations":822},"covid-19",[823],{"languageCode":694,"slug":824},"covid-19-fr",{"cursor":826,"node":827},"YXJyYXljb25uZWN0aW9uOjMx",{"name":602,"slug":828,"description":829,"translations":830},"cannabis-intoxication","Cannabis contains two well known components, Delta-9 Tetrahydrocannabinol (Δ-9-THC) and Cannabidiol (CBD). The psychoactive properties of cannabis are typically attributed to Δ-9-THC, which is present in variable concentrations dependent on the strain, and absorbed at variable rates dependent on the mode of ingestion. Acute intoxication is rare from cannabidiol (CBD) products unless given in excess or with high THC:CBD ratio. Since Canadian legalization of cannabis for adults, there has been an increasing rate of hospitalization for cannabis exposures in children 14 years and younger.",[831],{"languageCode":694,"slug":832},"cannabis-intoxication-fr",{"cursor":834,"node":835},"YXJyYXljb25uZWN0aW9uOjMy",{"name":605,"slug":836,"description":837,"translations":838},"developmental-and-intellectual-disabilities","Children and youth with developmental or intellectual delays/disorders (DD) use Emergency Department (ED) 1.8 times more frequently than the general pediatric population. This population of patients includes those with autism spectrum disorder (ASD), fetal alcohol spectrum disorder (FASD), or other conditions. This document provides recommendations for the medical approach to these patients to assist in optimizing care.",[839],{"languageCode":694,"slug":840},"caring-for-children-with-developmental-and-intellectual-disabilities-fr",{"cursor":842,"node":843},"YXJyYXljb25uZWN0aW9uOjU5",{"name":608,"slug":844,"description":845,"translations":846},"child-abuse","Children under 3 years of age are at highest risk for serious injuries from abuse. Being alert to findings that suggest abuse will improve early recognition and prevent recurrent, escalating abuse. The extent of the workup performed in the emergency department will vary based on geography, acuity of injury, and services available. Early consultation with a Pediatric Referral Centre or child protection team is recommended.",[847],{"languageCode":694,"slug":848},"child-abuse-fr",{"cursor":850,"node":851},"YXJyYXljb25uZWN0aW9uOjMz",{"name":97,"slug":852,"description":853,"translations":854},"concussion","Concussion is a traumatic brain injury resulting from acceleration/deceleration forces from a direct blow to the head, face, neck or elsewhere on the body with an 'impulsive' force transmitted to the head. Loss of consciousness and amnesia are not required to make the diagnosis.",[855],{"languageCode":694,"slug":856},"concussion-fr",{"cursor":858,"node":859},"YXJyYXljb25uZWN0aW9uOjM0",{"name":104,"slug":860,"description":861,"translations":862},"constipation","Children with functional constipation (FC) often present to the ED with impaction or colicky abdominal pain. The prevalence of FC in infants and toddlers is approximately 20%. While organic causes are responsible for less than 5% of constipation in children, FC may mimic surgical causes of abdominal pain, such as appendicitis, intussusception and bowel obstruction, thus a careful assessment is required before making this diagnosis.",[863],{"languageCode":694,"slug":864},"constipation-fr",{"cursor":866,"node":867},"YXJyYXljb25uZWN0aW9uOjM3",{"name":111,"slug":868,"description":869,"translations":870},"croup","Croup is the most common cause of upper airway obstruction in children. It is characterized by acute onset of barky cough +/- stridor. The typical age of presentation is between 6 months and 5 years with a peak around 2 years. Consider other causes of upper airway obstruction such as bacterial tracheitis, epiglottitis and retropharyngeal abscess in children presenting with severe symptoms and a transient or lack of response to croup treatment.",[871],{"languageCode":694,"slug":872},"croup-fr",{"cursor":874,"node":875},"YXJyYXljb25uZWN0aW9uOjM2",{"name":617,"slug":876,"description":877,"translations":878},"critically-ill-neonate","A clinical tool to guide decision-making when caring for critically ill pediatric patients in emergency settings. \r\nUse in infants 0-28 days. At birth, refer to NRP guidelines. Not intended for preterm infants less than 37 weeks",[879],{"languageCode":694,"slug":880},"critically-ill-neonate-fr",{"cursor":882,"node":883},"YXJyYXljb25uZWN0aW9uOjM4",{"name":119,"slug":884,"description":885,"translations":886},"dka","Diabetic ketoacidosis is a complication of new or existing pediatric diabetes and may be complicated by cerebral injury. Due to this risk, it is treated differently than adult DKA. Health care providers must follow a published pediatric-specific protocol when treating pediatric DKA. Early communication with the diabetes specialist at your pediatric referral site is a key element of the management of these patients. \r\n\r\nKey highlights include dehydration is a key component of DKA pathophysiology; all patients with DKA should receive a 20 ml/kg IV bolus of normal saline or Ringer's lactate over 20 minutes at the initiation of treatment, which can be repeated if the patient remains hypoperfused; ongoing fluids in DKA should be weight-based and account for the significant fluid deficit, with an increased maximum of 500 ml/hr; and every patient in DKA is at risk of cerebral injury before and during treatment, especially if DKA is more severe. Assess every patient with DKA for signs of cerebral injury and follow the TREKK DKA algorithm. \r\n\r\nIn June 2023, TREKK’s DKA resources have been updated to reflect the 2022 International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines.",[887],{"languageCode":694,"slug":888},"dka-fr",{"cursor":890,"node":891},"YXJyYXljb25uZWN0aW9uOjQyMQ==",{"name":622,"slug":892,"description":893,"translations":894},"eating-disorders","Eating disorders are complex biopsychosocial disorders with significant medical sequelae and a high mortality rate. They exist across diverse populations regardless of age, race, ethnicity, gender, sexual orientation, body habitus, and socioeconomic background. Over the past several years, eating disorder diagnoses have increased globally.",[895],{"languageCode":694,"slug":896},"troubles-alimentaires",{"cursor":898,"node":899},"YXJyYXljb25uZWN0aW9uOjExNA==",{"name":625,"slug":900,"description":901,"translations":902},"febrile-seizures","A febrile seizure is a convulsion accompanied by a fever or illness. The child usually has muscle twitching, jerking or stiffness for a few minutes. The child usually loses consciousness and it is common for the child’s eyes to roll upward. Most children are sleepy afterward and are not responsive to your voice.\r\n\r\nFebrile seizures are common. Between 2-5% of children will have at least one febrile seizure when they are between 6 months and 5 years old. This video will help you to understand what is happening to your child and will help prepare you for your medical visit.",[903],{"languageCode":694,"slug":904},"febrile-seizures-fr",{"cursor":906,"node":907},"YXJyYXljb25uZWN0aW9uOjQw",{"name":126,"slug":908,"description":909,"translations":910},"fever","Neonates (less than or equal to 28 days of age) and young infants (29-60 days of age) with fever account for a significant number of emergency department (ED) visits. At this age, there is an increased risk of urinary tract infections and invasive bacterial infections (IBIs), specifically bacteremia and bacterial meningitis. Most febrile young infants have self-limited viral illnesses, however up to 2-3% harbour life-threatening IBIs. Clinical examination can be unreliable in determining the source or severity of infection. The difficulty lies in differentiating the infant with IBIs from those without, while minimizing the risks of over-investigations. Additionally, infants with IBIs are at risk of poor outcomes if not diagnosed and treated promptly.",[911],{"languageCode":694,"slug":912},"fever-fr",{"cursor":914,"node":915},"YXJyYXljb25uZWN0aW9uOjQx",{"name":133,"slug":916,"description":917,"translations":918},"fractures","Children break bones more easily than adults - so pediatric fractures are very common. There are several unique features of the pediatric musculoskeletal system that need to be considered in management decisions of all of these injuries - growth plates, plasticity, callus formation, remodeling potential, and partial breaks are some of the key ones. Recognition and appropriate management of pediatric fractures by ED providers is critical. While some common minor wrist and ankle fractures can be treated with a less conservative approach encouraging an early return to activities, other fractures if not treated properly can result in long term functional problems for the child and/or be a sign of child maltreatment.",[919],{"languageCode":694,"slug":920},"fractures-fr",{"cursor":922,"node":923},"YXJyYXljb25uZWN0aW9uOjQy",{"name":141,"slug":924,"description":140,"translations":925},"gastroenteritis",[926],{"languageCode":694,"slug":927},"gastroenteritis-fr",{"cursor":929,"node":930},"YXJyYXljb25uZWN0aW9uOjYx",{"name":634,"slug":931,"description":932,"translations":933},"hand-foot-mouth","Hand-foot-mouth disease or coxsackie is a common viral illness that most children get at some point that can cause symptoms including fever, rash, spots in the mouth and decreased feeding. This short video will help you to understand what to expect when your child has coxsackie and how you can care for them.",[934],{"languageCode":694,"slug":935},"hand-foot-mouth-fr",{"cursor":937,"node":938},"YXJyYXljb25uZWN0aW9uOjExMA==",{"name":637,"slug":939,"description":14,"translations":940},"high-flow-nasal-cannula",[941],{"languageCode":694,"slug":942},"high-flow-nasal-cannula-fr",{"cursor":944,"node":945},"YXJyYXljb25uZWN0aW9uOjQ0",{"name":148,"slug":946,"description":947,"translations":948},"intussusception","Intussusception is invagination of the intestine into an adjacent segment, most commonly involving the ileocecal valve. This process occludes blood supply to the bowel and can progress from tissue ischemia to necrosis/perforation. It is most likely to be idiopathic, but can be caused by a variety of pathological lead points.",[949],{"languageCode":694,"slug":950},"intussusception-fr",{"cursor":952,"node":953},"YXJyYXljb25uZWN0aW9uOjQ2",{"name":642,"slug":954,"description":955,"translations":956},"meningitis","Most cases of childhood meningitis are caused by an enterovirus. Bacterial meningitis is less common, with 90% of cases occurring in children less than 5 years of age. Bacterial meningitis has a mortality rate of 20% in infants and 2% in children; neurologic sequalae occur in approximately one-third of children who survive their infection. Early diagnosis and treatment of bacterial meningitis is associated with better outcomes. Viral meningitis is a diagnosis of exclusion.",[957],{"languageCode":694,"slug":958},"meningitis-fr",{"cursor":960,"node":961},"YXJyYXljb25uZWN0aW9uOjEwNQ==",{"name":645,"slug":962,"description":963,"translations":964},"mental-health-self-assessment-tool","On this page, you will find evidence-based tools and information surrounding pediatric mental health concerns. The information provided on TREKK.ca is designed to complement, not replace, the relationship between a patient and their own physician or healthcare provider.",[965],{"languageCode":694,"slug":966},"mental-health-self-assessment-tool-fr",{"cursor":968,"node":969},"YXJyYXljb25uZWN0aW9uOjQ3",{"name":156,"slug":970,"description":155,"translations":971},"multisystem-trauma",[972],{"languageCode":694,"slug":973},"multisystem-trauma-fr",{"cursor":975,"node":976},"YXJyYXljb25uZWN0aW9uOjQ4",{"name":164,"slug":977,"description":163,"translations":978},"pain-treatment",[979],{"languageCode":694,"slug":980},"pain-treatment-fr",{"cursor":982,"node":983},"YXJyYXljb25uZWN0aW9uOjUx",{"name":652,"slug":984,"description":985,"translations":986},"procedural-pain","Common medical procedures used to assess and treat children can cause significant pain and distress. Untreated pain has short-term (pain and distress for the child, caregivers, and healthcare providers; prolonged procedure time; slower healing) and long-term consequences (increased sensitivity to pain; avoidance of healthcare settings; needle phobia, higher levels of anxiety before a procedure). Timely and effective multi-modal pain care improves procedure success rates, prevents the need for repeated attempts, improves patient flow, and improves patient and caregiver satisfaction. Before initiating any procedure: consider whether it is truly necessary, batch procedures together, optimize pain management, and engage caregivers in planning/decision-making. ",[987],{"languageCode":694,"slug":988},"procedural-pain-fr",{"cursor":990,"node":991},"YXJyYXljb25uZWN0aW9uOjUy",{"name":655,"slug":992,"description":993,"translations":994},"procedural-sedation","A brief summary of current knowledge needed to perform safe and effective procedural sedation in children.",[995],{"languageCode":694,"slug":996},"procedural-sedation-fr",{"cursor":998,"node":999},"YXJyYXljb25uZWN0aW9uOjU0",{"name":658,"slug":1000,"description":1001,"translations":1002},"sepsis","Sepsis is a systemic response to infection; it is a leading cause of morbidity and mortality worldwide. Early recognition, aggressive resuscitation (fluids, metabolic correction, antibiotics) and escalation of care (vasoactive medications) are key to improving patient outcomes.",[1003],{"languageCode":694,"slug":1004},"sepsis-fr",{"cursor":1006,"node":1007},"YXJyYXljb25uZWN0aW9uOjU1",{"name":661,"slug":1008,"description":1009,"translations":1010},"severe-head-injury","Head trauma is considered severe in a child with a Glasgow Coma Scale (GCS) score of ≤ 8. These children often have intracranial injury identified on neuroimaging and all have suffered traumatic brain injury (TBI). Injury is the leading cause of death in children >1 year of age, and TBI is the most significant cause of death and disability across all ages.",[1011],{"languageCode":694,"slug":1012},"severe-head-injury-fr",{"cursor":1014,"node":1015},"YXJyYXljb25uZWN0aW9uOjU2",{"name":664,"slug":1016,"description":1017,"translations":1018},"scd","Sickle cell disease (SCD) is a genetic disorder of hemoglobin, in which sickling of red blood cells results in hemolysis and vasoocclusion. Newborn screening has led to early identification of SCD in many regions across Canada. While homozygous SCD (HbSS) is the most severe, other sickling syndromes (e.g., HbSC) may present similarly.",[1019],{"languageCode":694,"slug":1020},"scd-fr",{"cursor":1022,"node":1023},"YXJyYXljb25uZWN0aW9uOjU3",{"name":180,"slug":1024,"description":179,"translations":1025},"status-epilepticus",[1026],{"languageCode":694,"slug":1027},"status-epilepticus-fr",{"cursor":1029,"node":1030},"YXJyYXljb25uZWN0aW9uOjU4",{"name":188,"slug":1031,"description":187,"translations":1032},"suicidal-risk-screening-assessment",[1033],{"languageCode":694,"slug":1034},"suicidal-risk-screening-assessment-fr",{"cursor":1036,"node":1037},"YXJyYXljb25uZWN0aW9uOjYw",{"name":196,"slug":1038,"description":1039,"translations":1040},"uti","UTI is among the most common serious bacterial infections seen in infants and children. UTI with fever is indicative of an upper tract infection/pyelonephritis, as opposed to afebrile cystitis. It is important to diagnose and empirically treat febrile UTIs in infants and children, as delayed treatment may increase the risk of bacteremia. There are a number of risk factors associated with increased rates of UTI in young children such as age, gender and height of fever. ",[1041],{"languageCode":694,"slug":1042},"uti-fr",{"cursor":1044,"node":1045},"YXJyYXljb25uZWN0aW9uOjEwMw==",{"name":673,"slug":1046,"description":1047,"translations":1048},"visiting-ed","The Emergency Department (ED) is a place where people go for immediate care.\r\nVisiting the ED can be scary and overwhelming, especially when you don’t know what to expect. We hope these resources helps reduce stress and helps you prepare.\r\n",[1049],{"languageCode":694,"slug":1050},"visiting-ed-fr",{"debug":1052,"queryAnalyzer":1053},[],{"keys":1054,"keysLength":1055,"keysCount":1056,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":1057},"9ba504182e5375d8ee802ccd07f58575ad4f11b79a3c746ac62c55429115da0f graphql:Query list:topic dGVybTo0ODE= dGVybTo0NzY= dGVybTo0Njk= dGVybTo0NDc= dGVybTo0NTQ= dGVybTo0NTg= dGVybTo0NjE= dGVybTo0NjM= dGVybTo0NjQ= dGVybTo0NzE= dGVybTo0NzI= dGVybTo0MzI= dGVybTo0MzQ= dGVybToyMg== dGVybToyNQ== dGVybToyNw== dGVybToyOA== dGVybTozMA== dGVybTozNQ== dGVybTozMQ== dGVybTozMg== dGVybTo1OQ== dGVybTozMw== dGVybTozNA== dGVybTozNw== dGVybTozNg== dGVybTozOA== dGVybTo0MjE= dGVybToxMTQ= dGVybTo0MA== dGVybTo0MQ== dGVybTo0Mg== dGVybTo2MQ== dGVybToxMTA= dGVybTo0NA== dGVybTo0Ng== dGVybToxMDU= dGVybTo0Nw== dGVybTo0OA== dGVybTo1MQ== dGVybTo1Mg== dGVybTo1NA== dGVybTo1NQ== dGVybTo1Ng== dGVybTo1Nw== dGVybTo1OA== dGVybTo2MA== dGVybToxMDM=",713,51,[],{"data":1059,"extensions":1153},{"footer_1":1060,"footer_2":1078,"footer_3":1105,"footer_privacy":1118,"social":1125,"footer":1139},{"edges":1061},[1062,1067,1072],{"cursor":1063,"node":1064},"YXJyYXljb25uZWN0aW9uOjE2Ng==",{"label":29,"uri":31,"target":14,"menu":1065},{"node":1066},{"name":12},{"cursor":1068,"node":1069},"YXJyYXljb25uZWN0aW9uOjIwMzg=",{"label":36,"uri":38,"target":14,"menu":1070},{"node":1071},{"name":12},{"cursor":1073,"node":1074},"YXJyYXljb25uZWN0aW9uOjE2OA==",{"label":1075,"uri":13,"target":14,"menu":1076},"All Topics",{"node":1077},{"name":12},{"edges":1079},[1080,1085,1090,1095,1100],{"cursor":1081,"node":1082},"YXJyYXljb25uZWN0aW9uOjE2OQ==",{"label":441,"uri":435,"target":14,"menu":1083},{"node":1084},{"name":448},{"cursor":1086,"node":1087},"YXJyYXljb25uZWN0aW9uOjE3MA==",{"label":448,"uri":481,"target":14,"menu":1088},{"node":1089},{"name":448},{"cursor":1091,"node":1092},"YXJyYXljb25uZWN0aW9uOjE3MQ==",{"label":455,"uri":487,"target":14,"menu":1093},{"node":1094},{"name":448},{"cursor":1096,"node":1097},"YXJyYXljb25uZWN0aW9uOjE3Mg==",{"label":462,"uri":493,"target":14,"menu":1098},{"node":1099},{"name":448},{"cursor":1101,"node":1102},"YXJyYXljb25uZWN0aW9uOjIxMjk=",{"label":469,"uri":499,"target":14,"menu":1103},{"node":1104},{"name":448},{"edges":1106},[1107,1113],{"cursor":1108,"node":1109},"YXJyYXljb25uZWN0aW9uOjE3NA==",{"label":506,"uri":507,"target":14,"menu":1110},{"node":1111},{"name":1112},"Info",{"cursor":1114,"node":1115},"YXJyYXljb25uZWN0aW9uOjE3Mw==",{"label":510,"uri":511,"target":14,"menu":1116},{"node":1117},{"name":1112},{"edges":1119},[1120],{"cursor":1121,"node":1122},"YXJyYXljb25uZWN0aW9uOjE3NQ==",{"label":1123,"uri":1124,"target":14},"Terms of Use","/terms-of-use/",{"edges":1126},[1127,1130,1133,1136],{"cursor":1128,"node":1129},"YXJyYXljb25uZWN0aW9uOjE5Nw==",{"label":516,"url":517,"target":14},{"cursor":1131,"node":1132},"YXJyYXljb25uZWN0aW9uOjE5OA==",{"label":520,"url":521,"target":14},{"cursor":1134,"node":1135},"YXJyYXljb25uZWN0aW9uOjE5OQ==",{"label":524,"url":525,"target":14},{"cursor":1137,"node":1138},"YXJyYXljb25uZWN0aW9uOjIwMA==",{"label":528,"url":529,"target":14},{"optionsTheme":1140},{"newsletterTitle":1141,"newsletterTitleFr":1142,"newsletterDescription":1143,"newsletterDescriptionFr":1144,"newsletterUrl":1145,"newsletterUrlFr":1149,"landAcknowledgement":1151,"landAcknowledgementFr":1152},"Subscribe to our Newsletter","Abonnez-vous à notre bulletin d'information","When you subscribe to this e-update, new issues will be sent to your email address the moment they are published.","Lorsque vous vous abonnez à cette mise à jour électronique, les nouveaux numéros seront envoyés à votre adresse e-mail dès leur publication.",{"title":1146,"url":1147,"target":1148},"Subscribe","https://trekk.us16.list-manage.com/subscribe?u=31840b6f27d1074425db8898a&id=2c90e9e1a9","_blank",{"title":1150,"url":1147,"target":1148},"S'inscrire","\u003Cp>TREKK acknowledges that our network is situated on the unceded and ancestral territories of diverse Indigenous Peoples across Turtle Island. \u003C/p>\n\u003Cp>From coast to coast to coast, we respect and acknowledge Inuit, Métis, and First Nations Peoples as the traditional stewards of the lands we work and live on. For those of us who are settlers, we recognize that processes of colonization continue to impact Indigenous Peoples today. TREKK is committed to working toward cultural safety, decolonization, and reconciliation.\u003C/p>\n","\u003Cp>TREKK reconnaît que notre réseau est situé sur les territoires non cédés et ancestraux de divers peuples autochtones de l'Île de la Tortue.\u003C/p>\n\u003Cp>D’un océan à l’autre, nous respectons et reconnaissons les Inuits, les Métis et les Premières Nations en tant que gardiens traditionnels des terres sur lesquelles nous travaillons et vivons. Pour ceux d’entre nous qui sont des colons, nous reconnaissons que les processus de colonisation continuent d’avoir un impact sur les peuples autochtones aujourd’hui. TREKK s’engage à œuvrer en faveur de la sécurité culturelle, de la décolonisation et de la réconciliation.\u003C/p>\n",{"debug":1154,"queryAnalyzer":1155},[],{"keys":1156,"keysLength":1157,"keysCount":1158,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":1159},"d9a1e4a4227d63ecc282d2b69b4b64d07ba73e19765e9d47f113fdada604cd45 graphql:Query list:menuitem cG9zdDoxNjY= cG9zdDoyMDM4 cG9zdDoxNjg= cG9zdDoxNjk= cG9zdDoxNzA= cG9zdDoxNzE= cG9zdDoxNzI= cG9zdDoyMTI5 cG9zdDoxNzQ= cG9zdDoxNzM= cG9zdDoxNzU= cG9zdDoxOTc= cG9zdDoxOTg= cG9zdDoxOTk= cG9zdDoyMDA= YWNmX29wdGlvbnNfcGFnZTp0aGVtZS1zZXR0aW5ncw== dGVybTo3Ng== dGVybTo3Nw== dGVybTo3OA==",371,22,[],{"data":1161,"extensions":1266},{"resource":1162},{"title":1163,"databaseId":1164,"excerpt":680,"uri":1165,"language":1166,"translations":1168,"ptResources":1197},"Bottom Line Recommendations: Status Epilepticus",539,"/resources/bottom-line-recommendations-status-epilepticus/",{"code":1167},"en",[1169],{"slug":1170,"uri":1171,"title":1172,"languageCode":694,"ptResources":1173},"recommandations-de-base-status-epilepticus","/fr/resources/recommandations-de-base-status-epilepticus/","Recommandations de base: Status epilepticus",{"mainTitle":180,"subTitle":1174,"media":1175,"pdf":14,"link":14,"videos":14,"sections":1176},"* chez l’enfant de plus d’un mois","PDF",[1177,1179,1180,1181,1182,1183,1184,1186,1187,1189,1190,1191,1192,1193,1194,1195,1196],{"__typename":1178},"PtResourcesSectionsContentLayout",{"__typename":1178},{"__typename":1178},{"__typename":1178},{"__typename":1178},{"__typename":1178},{"__typename":1185},"PtResourcesSectionsCallOutLayout",{"__typename":1178},{"__typename":1188},"PtResourcesSectionsTableLayout",{"__typename":1185},{"__typename":1185},{"__typename":1178},{"__typename":1178},{"__typename":1178},{"__typename":1178},{"__typename":1178},{"__typename":1178},{"publish":1198,"description":1199,"eyebrow":1200,"mainTitle":180,"subTitle":1201,"lastUpdated":1202,"developed":14,"developedBy":1203,"developedByCopy":14,"underReview":1198,"englishOnlyFlag":1198,"multipleLanguages":1198,"mainImage":14,"media":1175,"pdf":1204,"link":14,"videos":14,"footnote":14,"sections":1209,"audience":1250,"topic":1255,"type":1259},false,"\u003Cp>Status Epilepticus is a time-sensitive emergency, since untreated seizures lead to more seizures and delayed treatment contributes to morbidity and mortality. Providing sufficient evidence based treatment early is essential to improve patient outcomes. If your patient is actively seizing, refer to TREKK and EIIC’s \u003Ca href=\"https://trekk.ca/resources/algorithm-status-epilepticus/\">Status Epilepticus Algorithm\u003C/a>.\u003C/p>\n","Bottom Line Recommendations: Summary of Pediatric Emergency Care Information for Healthcare Providers","*in children over 1 month of age","2025-05-05T00:00:00+00:00","Dr. Katherine Muir (CHEO); Sarah Buttle (CHEO); Dr. Dubravka A. Diksic (Montreal Children's Hospital)",{"cursor":1205,"node":1206},"YXJyYXljb25uZWN0aW9uOjQ4ODQ=",{"fileSize":1207,"mediaItemUrl":1208},294618,"https://cms.trekk.ca/wp-content/uploads/2025/05/2026_02_17-Status-Epilepticus-BLR-v1.2.pdf",[1210,1213,1216,1219,1222,1224,1227,1229,1231,1233,1236,1238,1241,1244,1247],{"__typename":1178,"title":1211,"subTitle":1198,"content":1212},"Summary","\u003Cp>\u003Cstrong>Status Epilepticus is a time-sensitive emergency, since untreated seizures lead to more seizures\u003C/strong> \u003Cstrong>and delayed treatment contributes to morbidity and mortality.\u003C/strong>\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/33552322/\" target=\"_blank\" rel=\"noopener\">1\u003C/a>\u003C/sup> \u003Cstrong>Providing sufficient evidence-\u003C/strong> \u003Cstrong>based treatment early is essential to improve patient outcomes. If your patient is actively seizing,\u003C/strong> \u003Cstrong>refer to\u003C/strong> \u003Ca href=\"https://trekk.ca/resources/algorithm-status-epilepticus\" target=\"_blank\" rel=\"noopener\">\u003Cstrong>TREKK and EIIC’s Status Epilepticus Algorithm\u003C/strong>\u003C/a>.\u003C/p>\n",{"__typename":1178,"title":1214,"subTitle":1198,"content":1215},"Making the Diagnosis","\u003Cul>\n\u003Cli>Seizures lasting longer than 5 minutes or multiple seizures without full recovery of consciousness between seizures warrant treatment as status epilepticus.\u003C/li>\n\u003Cli>To determine the underlying cause and manage concurrently, consider the following investigations, depending on the clinical situation:\n\u003Cul>\n\u003Cli>Electrolytes, glucose, urea, creatinine, CBC, blood/urine cultures, blood gas, LFTs and/or drug screen.\u003C/li>\n\u003Cli>Anti-convulsant levels if patient on treatment (e.g., phenytoin, carbamazepine, phenobarbital, valproic acid).\u003C/li>\n\u003Cli>Head CT if history of trauma, signs of increased intracranial pressure, and/or focal neurological signs.\u003C/li>\n\u003Cli>Lumbar puncture (LP) if suspicion for meningitis AND no focal neurologic findings on exam or contraindications to LP on imaging. Initiation of antimicrobials should \u003Cstrong>NOT\u003C/strong> be delayed if LP is not possible.\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003C/ul>\n",{"__typename":1178,"title":1217,"subTitle":1198,"content":1218},"Possible Etiologies","\u003Cul>\n\u003Cli>Fever, severe infection (meningitis, encephalitis), anoxic injury, hypo/hyperglycemia, hypo/hypernatremia, hypo/hypercalcemia, traumatic brain injury, anti-epileptic drug non- adherence/withdrawal/overdose, toxic exposure,  structural brain abnormality, hypoxic-ischemic encephalopathy, progressive neurodegenerative disorder, stroke, underlying  genetic condition.\u003C/li>\n\u003C/ul>\n",{"__typename":1178,"title":1220,"subTitle":1198,"content":1221},"Management","\u003Ch3>\u003Cstrong>PHASE 0 (GOAL 0-5 MINUTES)\u003C/strong>\u003C/h3>\n\u003Cul>\n\u003Cli>Maintain airway (suction secretions, position, jaw thrust), breathing (100% oxygen via non-rebreather mask +/- assisted ventilation), and circulation (monitor, IV access, isotonic fluid bolus if inadequate perfusion).\u003C/li>\n\u003C/ul>\n",{"__typename":1178,"title":14,"subTitle":1198,"content":1223},"\u003Ch3>\u003Cstrong>PHASE 1 (GOAL 5-15 MINUTES)\u003C/strong>\u003C/h3>\n\u003Ch3>PREHOSPITAL\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/24298939/\">2\u003C/a>\u003C/sup>\u003C/h3>\n\u003Cul>\n\u003Cli>\u003Cstrong>DO NOT\u003C/strong> wait to check blood glucose before initiating treatment or placing an IV/IO.\u003C/li>\n\u003Cli>Give Midazolam 0.2 mg/kg/dose IM/intranasal (MAX 10 mg/dose)\n\u003Cul>\n\u003Cli>Consider standardized Midazolam dose: 5 mg/dose for 13-40 kg; 10 mg/dose for >40 kg via IM/intranasal route.\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003Cli>\u003Cstrong>Check blood glucose:\u003C/strong>\n\u003Cul>\n\u003Cli>\u003Cstrong>If blood glucose <3.3 mmol/L (<60 mg/dL):\u003C/strong> Treat with D25W 2 mL/kg/dose IV (MAX 100 mL/dose) OR D10W 5 mL/kg/dose IV (MAX 250 mL/dose).\u003C/li>\n\u003Cli>\u003Cstrong>If ≥3.3\u003C/strong> \u003Cstrong>mmol/L (≥60 mg/dL):\u003C/strong> Give second dose of Midazolam 0.2 mg/kg/dose IM/intranasal (MAX cumulative dose of 10 mg in prehospital setting; if max dose given, consult Medical Director/Base Hospital for next step).\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003C/ul>\n\u003Ch3>EMERGENCY DEPARTMENT\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/29320603/\">3\u003C/a>\u003C/sup>\u003C/h3>\n\u003Cul>\n\u003Cli>Give a benzodiazepine (if two doses not already given prior to ED arrival):\n\u003Cul>\n\u003Cli>IV/IO Access:\n\u003Cul>\n\u003Cli>Lorazepam 0.1 mg/kg/dose IV/IO (MAX 4 mg/dose) OR\u003C/li>\n\u003Cli>Midazolam 0.1 mg/kg/dose IV/IO (MAX 10 mg/dose)\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003Cli>No IV/IO Access:\n\u003Cul>\n\u003Cli>Midazolam 0.2 mg/kg/dose IM/intranasal (MAX 10 mg/dose)\u003C/li>\n\u003Cli>Consider standardized Midazolam dose: 5 mg/dose for 13-40 kg; 10 mg/dose for >40 kg via IM/intranasal route.\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003Cli>Check blood glucose and respond as per Prehospital section above (if not already done prior to ED arrival).\u003C/li>\n\u003Cli>Give a second benzodiazepine dose for ongoing seizures 5 minutes after the first dose.\u003C/li>\n\u003Cli>If IV/IO access becomes available, switch to IV/IO route.\u003C/li>\n\u003C/ul>\n",{"__typename":1185,"style":1225,"text":1226},"Caution","\u003Cul>\n\u003Cli>\u003Cstrong>DO NOT\u003C/strong> give more than two doses of benzodiazepine due to increased risk of apnea.\u003C/li>\n\u003C/ul>\n",{"__typename":1178,"title":14,"subTitle":1198,"content":1228},"\u003Ch3>\u003Cstrong>PHASE 2 (GOAL 15-50 MINUTES)\u003C/strong>\u003C/h3>\n\u003Cul>\n\u003Cli>Levetiracetam, Phenytoin/Fosphenytoin and Valproic acid are equally efficacious for status epilepticus.\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/32203691/\" target=\"_blank\" rel=\"noopener\">4\u003C/a>\u003C/sup> If available, Levetiracetam is preferred given rapid administration, favourable side effect profile, and fewer drug interactions.\u003C/li>\n\u003C/ul>\n",{"__typename":1188,"title":14,"table":1230},"{\"table_options\":{\"ca\":\"\",\"ct\":\"ed\",\"tb\":\"full\",\"uh\":\"y\",\"uf\":\"y\",\"sc\":\"n\",\"st\":\"\",\"cols\":4,\"rows\":5,\"changed\":true},\"table_param\":{\"plugin_version\":\"1.7.2\",\"field_name\":\"table\",\"field_key\":\"field_69af09ef3dd2a\"},\"columns\":[{\"c\":\"\",\"o\":[]},{\"c\":\"\",\"o\":[]},{\"c\":\"\",\"o\":[]},{\"c\":\"\",\"o\":[]}],\"caption\":\"\",\"tbody\":[{\"c\":[{\"c\":\"\u003Cp>Levetiracetam\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>60 mg\\/kg\\/dose IV\\/IO (MAX 3000 mg\\/dose) Infuse over 5 minutes\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>Any age\u003Csup>\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/32203691\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">4\u003C\\/a>\u003C\\/sup> \u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>\\u2193 side effects\\/drug interactions, low risk of psychosis\u003C\\/p>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Fosphenytoin\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>20 mg phenytoin equivalent (PE)\\/kg\\/dose IV\\/IO\\/IM (MAX 1000 mg PE\\/dose) Infuse over 10 minutes\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>Any age\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>\\u2193BP, \\u2193HR, arrhythmia; avoid in toxicologic seizures; choose alternate drug if on phenytoin at home or consider partial loading dose of 10 mg PE\\/kg\\/dose \u003C\\/p>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Valproic Acid\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>40 mg\\/kg\\/dose IV\\/IO (MAX 3000 mg\\/dose) Infuse over 10 minutes\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>\\u2265 2 years \u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>In Canada, only available via Health Canada Special Access Program; caution in patients with liver dysfunction, 4 mitochondrial disease, urea disorder, thrombocytopenia or unexplained developmental delay \u003C\\/p>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Phenytoin\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>20 mg\\/kg\\/dose IV\\/IO (MAX 1000 mg\\/dose) \u003Cstrong>Infuse over 20 minutes\u003C\\/strong>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>Any age\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>\\u2193BP, \\u2193HR, arrhythmia; avoid in toxicologic seizures; choose alternate drug if on phenytoin at home or consider partial loading dose of 10 mg kg\\/dose; use only if Fosphenytoin not available \u003C\\/p>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Phenobarbital\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>20 mg\\/kg\\/dose IV\\/IO (MAX 1000 mg\\/dose) \u003Cstrong>Infuse over 20 minutes\u003C\\/strong>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>\u003Cstrong>< 6 mos\u003C\\/strong>\u003Csup>\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/33552322\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">1\u003C\\/a>\u003C\\/sup>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp>Respiratory depression, especially in combination with benzodiazepines\u003C\\/p>\",\"o\":[]}],\"o\":[]}],\"tfoot\":[{\"c\":[{\"c\":\"\",\"o\":{\"cs\":4}}],\"o\":[]}],\"thead\":[{\"c\":[{\"c\":\"\u003Cp style=\\\"text-align: center;\\\">\u003Cstrong>Drug\u003C\\/strong>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp style=\\\"text-align: center;\\\">\u003Cstrong>Dose\u003C\\/strong>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp style=\\\"text-align: center;\\\">\u003Cstrong>Age\u003C\\/strong>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp style=\\\"text-align: center;\\\">\u003Cstrong>Comments\\/Cautions\u003C\\/strong>\u003C\\/p>\",\"o\":[]}],\"o\":[]}]}",{"__typename":1185,"style":1225,"text":1232},"\u003Cp>\u003Cstrong>DO NOT combine Phenytoin and Fosphenytoin.\u003C/strong>\u003C/p>\n",{"__typename":1185,"style":1234,"text":1235},"Danger","\u003Cp>\u003Cstrong>IF PATIENT IS STILL SEIZING 5 MINUTES AFTER END OF MEDICATION INFUSION, CHOOSE A\u003C/strong> \u003Cstrong>DIFFERENT SECOND-LINE AGENT FROM THIS LIST TO GIVE NEXT. CONTACT PEDIATRIC REFERRAL SITE.\u003C/strong>\u003C/p>\n",{"__typename":1178,"title":14,"subTitle":1198,"content":1237},"\u003Ch3>\u003Cstrong>PHASE 3 (GOAL 50 MINUTES ONWARDS)\u003C/strong>\u003C/h3>\n\u003Cul>\n\u003Cli>If two second-line therapies fail, discuss further management with Pediatric Referral Site.\u003C/li>\n\u003Cli>Anticipate the need/prepare for definitive airway support due to the risk of apnea.\u003C/li>\n\u003Cli>Third-line therapy consists of continuous IV infusion of Midazolam, Pentobarbital, Propofol OR Ketamine.\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/32822230/\">5\u003C/a>\u003C/sup>\u003C/li>\n\u003C/ul>\n\u003Ch3>MONITORING\u003C/h3>\n\u003Cul>\n\u003Cli>Monitor heart rhythm, pulse oximetry, and blood pressure.\u003C/li>\n\u003Cli>Anticipate apnea and/or hypotension with the use of multiple medications.\u003C/li>\n\u003Cli>Neurology consult, continuous electroencephalogram (EEG) monitoring +/- video should be initiated (at Pediatric Referral Site) as soon as feasible for patients on continuous infusion or those with persistent altered mental status, need for pharmacological paralysis, and/or paroxysmal events suspected to be seizures.\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/25626778/\" target=\"_blank\" rel=\"noopener\">6\u003C/a>\u003C/sup>\u003C/li>\n\u003C/ul>\n\u003Ch3>CRITERIA FOR ADMISSION/TRANSFER TO PEDIATRIC REFERRAL SITE\u003C/h3>\n\u003Cul>\n\u003Cli>Patients with refractory seizures or who are not awake and responsive within 4-6 hours of ED arrival should be admitted/ transferred for further evaluation and/or monitoring.\u003C/li>\n\u003C/ul>\n\u003Ch3>CONSIDERATIONS FOR DISCHARGE HOME\u003C/h3>\n\u003Cul>\n\u003Cli>Discharge home may be considered in patients who have returned to baseline post seizure management in discussion with Pediatric Referral Site, taking into account parental comfort.\u003C/li>\n\u003Cli>Counsel parents/guardians on what to do if a seizure recurs at home using this resource (\u003Ca href=\"https://media.emscimprovement.center/documents/SFA_Flier_HQ_8.5x11_PDF.pdf\">Eng\u003C/a>/\u003Ca href=\"https://media.emscimprovement.center/documents/SFA_8.5x11_SPANISH_FINAL_0.pdf\">Esp\u003C/a>) or this resource (\u003Ca href=\"https://www.aboutkidshealth.ca/what-to-do-in-case-of-a-seizure\">Eng\u003C/a>/\u003Ca href=\"https://www.aboutkidshealth.ca/quoi-faire-en-cas-de-crise\">Fr\u003C/a>).\u003C/li>\n\u003C/ul>\n",{"__typename":1178,"title":1239,"subTitle":1198,"content":1240},"Development Team","\u003Cp>Thank you to the following \u003Cstrong>content experts\u003C/strong> who led the development of the Status Epilepticus Bottom Line Recommendations:\u003C/p>\n\u003Cp>\u003Cstrong>Katherine Muir, MD\u003C/strong>,\u003Cem> Children’s Hospital of Eastern Ontario (CHEO)\u003C/em>\u003C/p>\n\u003Cp>\u003Cstrong>Sarah Buttle MD\u003C/strong>, \u003Cem>Children’s Hospital of Eastern Ontario (CHEO)\u003C/em>\u003C/p>\n\u003Cp>\u003Cstrong>Dubravka A. Diksic, MDCM, FRCPC\u003C/strong>; \u003Cem>Pediatric Emergency Physician, Assistant Professor, Department of Pediatrics, Pediatric  Emergency Medicine, Montreal Children’s Hospital \u003C/em>\u003C/p>\n\u003Cp>Thank you to the \u003Ca href=\"https://trekk.ca/team?tab=2\">TREKK Editorial Committee\u003C/a>, editor Dr. Sarah Reid (\u003Ca href=\"https://www.cheo.on.ca/en/index.aspx\">CHEO\u003C/a>), who provided editorial support and expertise in  the development of this resource. Thank you as well to Mateja Carevic, TREKK Project Coordinator (\u003Ca href=\"https://umanitoba.ca/\">University of Manitoba\u003C/a>) who coordinated the development process.\u003C/p>\n",{"__typename":1178,"title":1242,"subTitle":1198,"content":1243},"Key References","\u003Cp>(as cited in the Status Epilepticus Bottom Line Recommendations):\u003C/p>\n\u003Col>\n\u003Cli>McKenzie KC, Hahn CD, Friedman JN; \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/33552322/\">Canadian Paediatric Society, Acute Care Committee. Paediatr Child Health.\u003C/a> 2021; 26(1): 50-57.\u003C/li>\n\u003Cli>Shah MI, Macias CG, Dayan PS, Weik TS, Brown KM, Fuchs SM, Fallat ME, Wright JL, Lang ES. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/24298939/\">An evidencebased  guideline for pediatric prehospital seizure management using GRADE methodology.\u003C/a> Prehospital Emergency Care. 2014;  18(1):15-24.\u003C/li>\n\u003Cli>McTague A, Martland T, Appleton R. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/29320603/\">Drug Management for Acute Tonic-Clonic Convulsions Including Convulsive Status  Epilepticus in Children.\u003C/a> Cochrane Database of Systematic Reviews. 2018; Issue 1, Article No.: CD001905\u003C/li>\n\u003Cli>Chamberlain JM, Kapur J, Shinnar S, Elm J, Holsti M, Babcock L, Rogers A, Barsan W, Cloyd J, Lowenstein D, Bleck TP,  Conwit R, Melzner C, Cock H, Fountain NB, Underwood E, Connor JT, Silbergleit R. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/32203691/\">Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a doubleblind, response-adaptive,  randomized controlled trial.\u003C/a> Lancet. 2020; 395(10231): 1217-1224.\u003C/li>\n\u003Cli>Vossler DG, Bainbridge JL, Boggs JG, Novotny EJ, Loddenkemper T, Faught E, Amengual-Gual M, Fischer SN, Gloss DS,  Olson DM, Towne AR, Naritoku D, Welty TE. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/32822230/\">Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive  Review by the American Epilepsy Society Treatments Committee.\u003C/a> Epilepsy Curr. 2020 Sep;20(5):245-264. doi:  10.1177/1535759720928269. Epub 2020 Aug 21. PMID: 32822230; PMCID: PMC7576920.\u003C/li>\n\u003Cli>Herman ST, Abend NS, Bleck TP, Chapman KE, Drislane FW, Emerson RG, Gerard EE, Hahn CD, Husain AM, Kaplan PW,  LaRoche SM, Nuwer MR, Quigg M, Riviello JJ, Schmitt SE, Simmons LA, Tsuchida TN, Hirsch LJ; \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/25626778/\">Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society. Consensus statement on continuous EEG in critically ill  adults and children, part I: indications.\u003C/a> J Clin Neurophysiol. 2015 Apr;32(2):87-95. doi: 10.1097/WNP.0000000000000166. PMID: 25626778; PMCID: PMC4435533.\u003C/li>\n\u003C/ol>\n",{"__typename":1178,"title":1245,"subTitle":1198,"content":1246},"Evidence Repository","\u003Cp>For a complete list of the evidence that informed the creation of the Status Epilepticus Bottom Line Recommendations see the Evidence Repository \u003Ca href=\"https://trekk.ca/resources/evidence-repository-status-epilepticus\">here\u003C/a>.\u003C/p>\n",{"__typename":1178,"title":1248,"subTitle":1198,"content":1249},"Disclaimer","\u003Cp>The purpose of this document is to provide healthcare professionals with key facts and recommendations for the diagnosis and treatment of community acquired pneumonia in children in the emergency department. The TREKK Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. \u003Cstrong>THIS DOCUMENT IS SUBJECT TO FULL DISCLAIMER HERE:\u003C/strong> \u003Ca href=\"https://trekk.ca/terms-of-use\">trekk.ca/terms-of-use\u003C/a>\u003C/p>\n",{"edges":1251},[1252],{"cursor":541,"node":1253},{"name":29,"link":32,"slug":1254},"healthcare-providers",{"edges":1256},[1257],{"cursor":1022,"node":1258},{"name":180,"link":183,"slug":1024},{"edges":1260},[1261],{"cursor":1262,"node":1263},"YXJyYXljb25uZWN0aW9uOjEz",{"name":1264,"slug":1265},"Bottom Line Recommendations","bottom-line-recommendations",{"debug":1267,"queryAnalyzer":1268},[],{"keys":1269,"keysLength":1270,"keysCount":1271,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":1272},"133186b5af5831c3c36f3ef45ff95daea9edc1970b3684a1e4a67b06cad55990 graphql:Query cG9zdDo1Mzk= cG9zdDoyMDgx cG9zdDo0ODg0 dGVybToyMA== dGVybTo1Nw== dGVybToxMw==",156,8,[],1789077307395]