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4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] > [1] Status Epilepticus > Flashcards

[1] Status Epilepticus Flashcards

1
Q

What is status epilepticus?

A
  • A single seizure lasting more than 5 minutes

OR

  • 2 or more within 5 minutes without return to normal in between
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2
Q

How was status epilepticus previously defined?

A

Over a period of 30 minutes

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3
Q

What are the two categories of status epilepticus?

A
  • Convulsive

- Non-convulsive

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4
Q

What are the two types of non-convulsive status epilepticus?

A
  • Prolonged complex partial seizures

- Absence seizures

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5
Q

What percentage of cases of status epilepticus are non-convulsive?

A

Up to 25%

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6
Q

What percentage of people who have seizures or status epilepticus have epilepsy?

A

25%

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7
Q

What are some other possible causes of status epilepticus or status epilepticus like-presentation (besides epilepsy)?

A
  • Stroke
  • Haemorrhage
  • Intoxicants or adverse drug reactions
  • Problems with anticonvulsants
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8
Q

What problems with anticonvulsants can lead to seizures or status epilepticus?

A
  • Insufficient dosage
  • Sudden withdrawal
  • Alcohol consumption or withdrawal
  • Starting a new medication that affects anticonvulsant
  • Developed resistance
  • Gastroenteritis
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9
Q

What are the risk factors for status epilepticus?

A
  • <5 years or elderly
  • Genetic predisposition
  • Intellectual disability
  • Structural brain pathology
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10
Q

How doe convulsive status epilepticus present?

A

A regular pattern of contraction and extension of the arms and legs

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11
Q

How does non-convulsive status epilepticus present?

A

A long duration change in a person’s level of consciousness without large scale bending and extension of limbs

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12
Q

What investigations should be performed after an episode of acute status epilepticus to try and determine an underlying cause?

A
  • Anticonvulsant drug blood levels
  • Toxicology screen
  • Comprehensive metabolic panel
  • FBC
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13
Q

What are the differentials for status epilepticus?

A
  • Psychogenic non-epileptic SE
  • Delirium
  • Coma
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14
Q

What are the initial management steps for status epilepticus?

A
  • Secure airway
  • Give high flow O₂
  • Gain IV access
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15
Q

What may be used to secure airway in status epilepticus?

A

Adjuncts

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16
Q

What should IV access be used for in management of status epilepticus?

A

1) . Bolus of Lorazepam

2) . Bloods

17
Q

What dose of lorazepam is used initially in status epilepticus?

A

4mg

18
Q

What bloods can be taken in acute status epilepticus?

A
  • U&E
  • LFT
  • FBC
  • Glucose
  • Calcium
  • Toxicology screen
  • Anticonvulsant levels
19
Q

How many times can lorazepam be given in status epilepticus?

A

No more than twice

20
Q

When should a second dose of lorazepam be considered in status epilepticus?

A

If no response 10-20 minutes after the first

21
Q

What can be used instead of lorazepam in status epilepticus if immediate IV access is not possible?

A

Buccal midazolam

22
Q

If seizures continue after 2 doses of lorazepam what can be used in status epilepticus?

A

IV phenytoin 10mg/kg (max1g) at no more than 100mg/minute

23
Q

What can be given after initial IV phenytoin dose in status epilepticus?

A

Maintenance 100mg phenytoin/6-8 hours

24
Q

What should be monitored during treatment of status epilepticus with phenytoin?

A
  • Blood drug levels
  • ECG
  • BP
25
Q

For how long can a patient be treated for status epilepticus before anaesthetist is required?

A

20 minutes

26
Q

If a seizures goes on after 60 minutes despite initial lorazepam and phenytoin what may be needed?

A

Anaesthetic intervention to paralyse with propofol and ventilate with continuous EEG in ICU

27
Q

What treatment is available for status epilepticus caused by alcoholism?

A

Thiamine 250mg IV over 30 mins

28
Q

If glucose levels are abnormally low in status epilepticus what can be given?

A

Glucose 50ml 50% IV

29
Q

What other physiological parameters may need addressing in status epilepticus?

A
  • Acidosis

- Hypotension

30
Q

What percentage of status epilepticus patients die within 30 days?

A

10-30%

31
Q

What do the people who die within 30 days of status epilepticus tend to have?

A

Underlying brain condition causing seizures e.g. tumour or stroke

32
Q

What are the acute complications of status epilepticus?

A
  • Hyperthermia
  • Pulmonary oedema
  • Cardiac arrhythmias
  • Cardiovascular collapse
33
Q

What are the long term complications of status epilepticus?

A
  • Epilepsy
  • Encephalopathy
  • Focal neurological deficits

4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] (33 decks)

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