› Immediate priorities
› Airway patency
› If ongoing convulsions, lateral positioning and suction readiness
› Breathing adequacy
› Oxygen if hypoxemia or respiratory depression after benzodiazepine
› Circulation status
› If shock, isotonic fluid bolus 20 mL/kg and reassess
› Bedside glucose
› If glucose <3.0 mmol/L, dextrose
› D10W 5 mL/kg IV
› D25W 2 mL/kg IV
› D50W 1 mL/kg IV for adolescents
› Seizure time and response
› Time since onset
› If >5 minutes, benzodiazepine pathway
› Return to baseline mental status
› If persistent altered mental status, expanded evaluation and admission pathway
› Fever and infection risk stratification
› Signs of CNS infection
› If meningeal signs, petechiae, toxic appearance, or persistent encephalopathy, meningitis encephalitis pathway
› Immunization status
› If underimmunized for Hib or pneumococcus, lower threshold for lumbar puncture when indicated
Classification and key decision points
› Febrile seizure phenotypes
› Simple criteria
› Generalized onset
› Duration <15 minutes
› Single seizure in 24 hours
› No prior neurologic deficit
› Complex criteria
› Focal features
› Duration 15 minutes or more
› More than one seizure in 24 hours
› Postictal deficit
› Febrile status epilepticus
› Continuous seizure 30 minutes or more
› Recurrent seizures without return to baseline
› High risk features
› Persistent focal neurologic deficit
› Neuroimaging consideration
› Persistent altered mental status
› Lumbar puncture consideration
› Concern for trauma
› Neuroimaging consideration
› Severe dehydration or inability to tolerate oral intake
› IV fluids and observation or admission consideration
› Unreliable follow up or caregiver concern
› Observation or admission consideration
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