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Emergency Medicine > Acute Seizures > Flashcards

Acute Seizures Flashcards

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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)

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2
Q

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

A

>50%

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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)

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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
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5
Q

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

A
  • BP
  • Urine dipstick - protein
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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?
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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
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8
Q

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

A
  • Cap glucose
  • Bloods - FBC, U+E’s, Ca2+, VBG, Anticonvulsant levels, clotting
  • ECG
  • Consider LP, BCs - infection
  • If cause unkown - Consider CT/MRI head/EEG
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9
Q

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

A

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

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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
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11
Q

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

A

4mg

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12
Q

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

A

10 mg IV diazepam

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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

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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

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15
Q

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

A

15-18 mg/kg IV

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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
27
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

28
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

29
Q

When would you not use phenytoin to treat status epilepticus?

A
  • Bradycardia
  • Heart block
30
Q

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

A

Hypotension

31
Q

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

A

Respiratory arrest - during last part of injection

32
Q

What monitoring would you perform in someone in status epilepticus?

A
  • Pulse oximetry
  • Cardiac Monitor
33
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

34
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

35
Q

How would you correct hypotension in someone in status epilepticus?

A

Fluids

36
Q

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

A

A few hours

37
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
38
Q

What are common neurological causes of seizures?

A
  • Epilepsy
  • Brain tumour
  • Meningitis/encephalitis
  • Post-stroke
  • Head Trauma
  • Congenital abnormalities/hypoxic injury
39
Q

What are metabolic causes of seizures?

A
  • Hypoglycaemia
  • Hyponatraemia
  • Hypocalcaemia
  • Hyperuricaemia
40
Q

What drugs can cause seizures?

A
  • Overdoses
  • Illicit drugs of abuse
  • Alcohol withdrawal
  • Toxins
41
Q

What are respiratory complications of status epilepticus?

A
  • Hypoxia
  • Aspiration pneumonitis
  • Respiratory acidosis
42
Q

What are cardiovascular complications of status epilepticus?

A
  • Arrhythmias/Tachycardia
  • Hypo/hypertension
43
Q

What are neurological complications of status epilepticus?

A
  • Primary brain injury - excitotoxic neuronal brain injury
  • Secondary brain injury - hypotension, hypoperfusion, hypoxia
44
Q

What should you give immediately as someone starts seizing?

A

15L/min O2 therapy - non-rebreath mask

45
Q

Why might you take a VBG in someone with acute seizure?

A

Assess lactate levels and acidosis

46
Q

Why might you look at U+E’s and Ca2+ in someone with acute seizure?

A

Look for electrolyte abnormalities

47
Q

Why might you do an ECG in someone with acute seizure?

A

Look for features of prolonged QT interval

Emergency Medicine (32 decks)

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