Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gwen - Neurology > Acute Epilepsy - Status Epilepticus > Flashcards

Acute Epilepsy - Status Epilepticus Flashcards

1
Q

What is the definition of status epilepticus?

A

Continuous seizures for 30 minutes or longer (or two or more seizures without recovery of consciousness between them over a similar period)

Although this says >5 mins?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the risk of brain damage in someone having status epilepticus for the first time?

A

>50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Do all those in status epilepticus have tonic-clonic seizures?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If a patient was in status epilepticus and was pregnant, what might you consider as your differentials?

A
  • Eclampsia - following pre-eclampsia
  • Epilepsy - previously diagnosed or undiagnosed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If a patient was in status epilepticus and was pregnant, what investigations might you consider?

A
  • BP
  • Urine dipstick - protein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you initially manage someone in status epilepticus?

A

ABCDE

  • A - open, remove false teeth
  • B - 100% O2 + suction
  • C - IV access, BP, fluids
  • D - consider blood glucose
  • E - head injury?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When gaining IV access in someone in status epilepticus, what bloods would you want to take?

A
  • U+E’s
  • LFTs
  • FBC
  • Glucose
  • Ca2+
  • Toxicology screen
  • Anticonvulsant levels
  • ABG/VBG
  • Consider CO levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What initial investigations would you do in someone in status epilepticus?

A
  • Cap glucose
  • Bloods
  • ECG
  • Consider LP, BCs - infection
  • If cause unkown - Consider CT head/EEG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would you give in the first 10 minutes to attempt to terminate status epilepticus?

A

IV Lorazepam - 2-4mg; or IV Diazepam - 10 mg

(Repeated if no response in 2 mins, note causes resp depression and hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If you were uable to gain IV access to give medications, how would you administer benzodiazepines in an attempt to terminate status epilepticus?

A
  • Buccal Midazolam - 10 mg adult, 7.5 mg age 5-10, 5mg age 1-5
  • Diazepam PR - 10-20mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What dose of lorazepam would you initially give someone IV if they were in status epilepticus?

A

4mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What dose would you initially consider giving someone of diazepam if they were in status epilpeticus?

A

10 mg IV diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If there was no response to an initial dose of benzodiazepines (lorazepam/diazepam) after 10-20 minutes, what would you consider doing?

A

Give second dose of benzodiuazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If someone, after repeated benzodiazepine doses, was still in status epilepticus after 30 minutes, what would you consider giving them?

A

IV phenytoin

(Monitor ECG and BP as can cause arrhythmia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What dose of phenytoin would you consider giving to someone in status epilepticus?

A

15-18 mg/kg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What rate would you give IV phenytoin at in someone in status epilepticus?

A

50 mg/min

17
Q

What monitoring would you do whilst giving someone in status epilpeticus phenytoin infusion?

A
  • ECG
  • BP
18
Q

If, after 60-90 minutes, someone is still in status epilepticus following treatment with phenytoin and benzodiazepines, what would you consider doing?

A

Call anaesthetist/ITU physician - General anaesthesia (propofol) in ITU, intubation

19
Q

What is the general rule for when to call an anaesthatist when managing someone in status epilepticus?

A

Never spend longer than 20 mins on someone in status without help from anaesthatist

20
Q

When would you not use phenytoin to treat status epilepticus?

A
  • Bradycardia
  • Heart block
21
Q

When would you be cautious using phenytoin in someone in status epilepticus?

A

Hypotension

22
Q

What should you be wary of when giving someone IV benzodiazepines?

A

Respiratory arrest - during last part of injection

23
Q

What monitoring would you perform in someone in status epilepticus?

A
  • Pulse oximetry
  • Cardiac Monitor
24
Q

If you suspected a seizure was due to hypoglycaemia, what might you give in addition to standard treatment for status epilepticus?

A

50ml 50% glucose

25
Q

What would you give in addition to standard treatment for status epilepticus in someone where you think alcohol abuse may be an issue/the cause?

A

IV Pabrinex

26
Q

How would you correct hypotension in someone in status epilepticus?

A

Fluids

27
Q

How long can the post-ictal period last following status epilepticus?

A

A few hours

28
Q

What would you want to do once you have managed to terminate a status epilepticus?

A
  • Switch to oral drugs when possible
  • Find cause - History, mutli-system exam, investigations
  • Treat cause
  • Refer to neurology
  • Advise regarding driving and DVLA
29
Q

What are common neurological causes of seizures?

A
  • Epilepsy
  • Brain tumour
  • Meningitis/encephalitis
  • Post-stroke
  • Head Trauma
  • Congenital abnormalities/hypoxic injury
30
Q

What are metabolic causes of seizures?

A
  • Hypoglycaemia
  • Hyponatraemia
  • Hypocalcaemia
  • Hyperuricaemia
31
Q

What drugs can cause seizures?

A
  • Overdoses
  • Illicit drugs of abuse
  • Alcohol withdrawal
  • Toxins
32
Q

What are respiratory complications of status epilepticus?

A
  • Hypoxia
  • Aspiration pneumonitis
  • Respiratory acidosis
33
Q

What are cardiovascular complications of status epilepticus?

A
  • Arrhythmias/Tachycardia
  • Hypo/hypertension
34
Q

What are neurological complications of status epilepticus?

A
  • Primary brain injury - excitotoxic neuronal brain injury
  • Secondary brain injury - hypotension, hypoperfusion, hypoxia, cerebral oedema, thrombus, infarction
35
Q

What should you give immediately as someone starts seizing?

A

15L/min O2 therapy - non-rebreath mask

36
Q

Precipitating factors in known epileptics

A

Abruptly stopping/changing anti-epileptic medicaiton

Intercurrent illness

Alcohol/drug abuse

Poor compliance of therapy

Hypoglycaemia

(over 50% occur in pateints wihtout history of epilepsy)

37
Q

Metbaolic complications of status epilepticus

A

Dehydration and electrolyte disrutbance

Renal and hepatic failure

Gwen - Neurology (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions