Acute Epilepsy - Status Epilepticus Flashcards
What is the definition ofstatus epilepticus?
Continuous seizures for 30 minutes or longer (or two or more seizures without recovery of consciousness between them over a similar period)
What is the risk of brain damage in someone having status epilepticus for the first time?
>50%
Do all those in status epilepticus have tonic-clonic seizures?
Primarily, but can also have absence status (continous, stuporous state), focal status and epilepsia patiralis continua (seizure activity in one part fo the body e.g. finger or limb)
If a patient was in status epilepticus and was pregnant, what might you consider as your differentials?
- Eclampsia - following pre-eclampsia
- Epilepsy - previously diagnosed or undiagnosed
If a patient was in status epilepticus and was pregnant, what investigations might you consider?
- BP
- Urine dipstick - protein
How would you initially manage someone in status epilepticus?
ABCDE
- A - open, remove false teeth
- B - 100% O2 + suction
- C - IV access, BP, fluids
- D - consider blood glucose
- E - head injury?
When gaining IV access in someone in status epilepticus, what bloods would you want to take?
- U+E’s
- LFTs
- FBC
- Glucose
- Ca2+
- Toxicology screen
- Anticonvulsant levels
- ABG/VBG
- Consider CO levels
What initial investigations would you do in someone in status epilepticus?
- Cap glucose
- Bloods
- ECG
- Consider LP, BCs - infection
- If cause unkown - Consider CT head/EEG
What would you give in the first 10 minutes to attempt to terminate status epilepticus?
IV Lorazepam - 4mg; or IV Diazepam - 10 mg
If you were uable to gain IV access to give medications, how would you administer benzodiazepines in an attempt to terminate status epilepticus?
- Buccal Midazolam - 10 mg adult, 7.5 mg age 5-10, 5mg age 1-5
- Diazepam PR - 10-20mg
What dose of lorazepam would you initially give someone IV if they were in status epilepticus?
4mg
What dose would you initially consider giving someone of diazepam if they were in status epilpeticus?
10 mg IV diazepam
If there was no response to an initial dose of benzodiazepines (lorazepam/diazepam) after 10-20 minutes, what would you consider doing?
Give second dose of benzodiuazepines
If someone, after repeated benzodiazepine doses, was still in status epilepticus after 30 minutes, what would you consider giving them?
IV phenytoin
What dose of phenytoin would you consider giving to someone in status epilepticus?
15-18 mg/kg IV
What rate would you give IV phenytoin at in someone in status epilepticus?
50 mg/min
What monitoring would you do whilst giving someone in status epilpeticus phenytoin infusion?
- ECG
- BP
