// ============================================================
// bedside/seizure.js
// SEIZURE MANAGEMENT (status epilepticus pathway).
// Keeps its own local `d` + `row` helpers used by the refractory
// infusion rendering.
// ============================================================
import { S } from './shared.js';
function d(wt, mgPerKg, max) { var v = Math.round(wt * mgPerKg * 100) / 100; return max ? Math.min(v, max) : v; }
function row(phase, drug, dose, route, notes) {
return '| ' + phase + ' | ' + drug + ' | ' + dose + ' | ' + route + ' | ' + notes + ' |
';
}
// Visual pathway row — time badge + step card linked by vertical line
function stepRow(time, color, title, bodyHtml, isLast) {
return '' +
'
' +
'
' + time + '
' +
(isLast ? '' : '
') +
'
' +
'
' +
'
' + title + '
' +
'
' + bodyHtml + '
' +
'
' +
'
Enter weight (kg).
'; return; }
var d10Low = Math.round(wt * 2 * 10) / 10;
var d10High = Math.round(wt * 5 * 10) / 10;
var html = ' Status Epilepticus Pathway — ' + wt + ' kgTime = 0 at seizure onset. Do not pause between steps for benzo to take effect — act on the clock.
';
// 0 min — STABILIZE
html += stepRow('0 min', '#3b82f6', 'Stabilize',
'ABCs — position, 100% O2 via NC / NRB, suction. IV or IO × 2. Continuous SpO2, ECG, BP. ' +
'POC glucose — if <60 mg/dL: D10W ' + d10Low + '-' + d10High + ' mL IV (2-5 mL/kg). ' +
'Labs: CBC, CMP, Mg, Ca, Phos, VBG, lactate, AED levels, toxicology if unclear etiology. ' +
'Consider pyridoxine 100 mg IV in infants <18 mo or INH ingestion. Temperature: treat hyperthermia aggressively.'
);
// 5 min — 1ST BENZO
html += stepRow('5 min', '#8b5cf6', '1st benzodiazepine (give once, pick by access)',
S.drugTable(seizureRowsByPhase(wt, '1st benzo'))
);
// 10 min — 2ND BENZO
html += stepRow('10 min', '#a855f7', '2nd benzodiazepine — if still seizing',
'Repeat same agent + dose once. Prepare 2nd-line now (don\'t wait to see if benzo works). If apnea/airway compromise: BVM, consider advanced airway.'
);
// 20 min — 2ND-LINE
html += stepRow('20 min', '#f59e0b', '2nd-line anti-epileptic — pick one (ESETT: equivalent efficacy)',
S.drugTable(seizureRowsByPhase(wt, '2nd-line'))
);
// 30 min — 2nd of 2nd-line (optional)
html += stepRow('30 min', '#ef4444', 'Still seizing? Consider 2nd agent from 2nd-line OR proceed to refractory',
'If the first 2nd-line drug failed, give a different 2nd-line agent OR move directly to refractory therapy. Activate ICU, prepare for intubation. Confirm etiology not reversible (electrolytes, glucose, fever, toxin).'
);
// 40 min — REFRACTORY
html += stepRow('40 min', '#dc2626', 'Refractory status — intubate + continuous infusion + continuous EEG',
S.drugTable(
S.drugRow('Midazolam (1st-line infusion)', 'Bolus ' + d(wt, 0.2, 10) + ' mg → gtt ' + d(wt, 0.05, 2) + '-' + d(wt, 0.5, 18) + ' mg/hr (bolus 0.2 mg/kg, gtt 0.05-0.5 mg/kg/hr)', 'IV', 'Titrate to seizure control / burst suppression.') +
S.drugRow('Pentobarbital', 'Bolus ' + d(wt, 5, 200) + ' mg → gtt ' + d(wt, 1, null) + '-' + d(wt, 5, null) + ' mg/hr (bolus 5 mg/kg, gtt 1-5 mg/kg/hr)', 'IV', 'Causes hypotension — often need pressors.') +
S.drugRow('Propofol', 'Bolus ' + d(wt, 2, 100) + ' mg → gtt ' + d(wt, 2, null) + '-' + d(wt, 5, null) + ' mg/hr (bolus 2 mg/kg, gtt 2-5 mg/kg/hr)', 'IV', 'PRIS risk in children — limit to <4 mg/kg/hr and duration <48 h.') +
S.drugRow('Ketamine', 'Bolus ' + d(wt, 2, 100) + ' mg → gtt ' + d(wt, 1, null) + '-' + d(wt, 5, null) + ' mg/hr (bolus 2 mg/kg, gtt 1-5 mg/kg/hr)', 'IV', 'NMDA antagonist — rescue. Good BP profile; useful if refractory to GABAergics.')
) +
'Continuous EEG within 1 h — target electrographic seizure suppression × 24-48 h, then wean. Reassess etiology: CNS imaging, LP, expanded workup.
'
, true);
// Key points
html += 'Key points
' +
'• Do NOT wait for benzo response before starting the 2nd-line — parallel preparation.
' +
'• Maximum 2 benzo doses total (1 pre-hospital + 1 in ED, or 2 in ED).
' +
'• Respiratory depression is common — have BVM, airway equipment, naloxone, flumazenil accessible (but avoid flumazenil here).
' +
'• ESETT trial: levetiracetam = fosphenytoin = valproate for efficacy. Pick by tolerability / contraindications.
' +
'• Always reassess: ongoing seizure? Non-convulsive status? Pseudo-seizure? → continuous EEG if any doubt.
';
html += 'Based on AES Guidelines 2016 and ESETT (Kapur et al., NEJM 2019). Verify all doses against institutional protocols.
';
resultDiv.innerHTML = html;
}
export function init() {
document.addEventListener('click', function(e) {
if (e.target.id === 'btn-seizure-calc' || e.target.closest('#btn-seizure-calc')) calcSeizure();
});
}