FN: status Epilepticus

Question 1

Definition

Answer 1

Seizue lasting >30min or repeated seizures w/o intervening conciousness

Question 2

Investigations

Answer 2

BM
Bloods: glucose, ABG, U+E, FBC, Calcium
ECG, EEG

Question 3

Investigations consider

Answer 3

AED levels
Tox screen
LP
BetaHCG
CT

Question 4

Drugs

Answer 4

Lorazepam
phenytoin
Diazepam infusion
Dexamethasone

Question 5

Lorazepam

Answer 5

2-4mg IV bolus over 30s

2nd dose if no response w/i 2min

Question 6

Alternatives to lorazepam

Answer 6

Diazepam 10mg IV/PR (20mg max)

Midazolam 10mg buccal

Question 7

Phenytoin

Answer 7

18mg/kg IVI @ 50mg/min
100mg/6-8h maintenance
Monitor ECG and BP

Question 8

Phenytoin CI

Answer 8

Bradycardia or heart blck

Question 9

Diazepam infusion

Answer 9

100mg in 500ml 5% dex @ 40ml/hr (3mg/kg/24hrs)

Question 10

Dexamethasone

Answer 10

10m IV if vasculitis/cerebral oedema (tumour) possible

Question 11

Acute Management

Answer 11

ABC

1. Oral/nasal airway, intubate
2. Suction
3. 10% oxygen
4. Capillary blood glucose

Question 12

Step 2

Answer 12

IV access + bloods

1. U+E, LFT, FBC, glucose, calcium
2. AED levels
3. Tx screen

Question 13

Step 3

Answer 13

Reverse Potential Causes

1. Thiamine 250mg if EtOH
2. 100ml 20% gucose unless glucose known to be normal

Question 14

Step 4

Answer 14

Slow IV bolus phase

1. lorazepam 2-4mg IV
2. 2nd dose if no response w/i 2min

Question 15

Step 5

Answer 15

IV infusion phase

1. Phenytoin 18mg/kg IVI (them 100mg/6-8h)
2. Or diazepam 100mg in 500ml 5% dex IVI

Question 16

Step 6

Answer 16

RSI Phase

Never spend >20min with someone in status w/o getting an anaesthetist