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CPS: Acute care Committee > Generalised Convulsivd > Flashcards

Generalised Convulsivd Flashcards

1
Q

What do they mean regarding ‘impending’ status epilepticus?

A

Continuous or intermittent seizures lasting longer than 5 minutes without full recovery of consciousness in between seizures

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2
Q

What is the incidence of CSE?

A

10-73 episodes per 100000 children

highest in kids under 2!150/100000

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3
Q

What is the mortality of CSE?

A

2-8%

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4
Q

What special population has the highest morbidity with CSE?

A

Neurological disorder: 10 - 20%

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5
Q

What are the overall objectives it CSE?

A
  1. Maintenance of ABCs
  2. Termination of seizures and prevention of recurrence
  3. Diagnosis and initial therapy for life threatening causes of CSE
  4. Arrange appropriate recital or ongoing care.

+/- management if refractory status epilepticus

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6
Q

Why do kids with CSE have airway/oxygen problems?

A

Clenched jaw
Poorly coordinated restorations
Secretions
Vomit

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7
Q

How do you manage a patient with CSEs airway

A 
Suction. 
Do not prie apart jaw/teeth
Oxygen 100%
Head tilt chin lift 
\+/- assisted ventilation

Monitors

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8
Q

Why would patients get bradycardic or hypotensive

A

Hypoxia

Very ominous signs!

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9
Q

At what point does brain damage start to occur?

A

In animal models, ischaemic and excitotoxic neuronal cell loss starts after 30 minutes.

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10
Q

Why do we give meds at 5 minutes?

A

Because seizures that last longer than 5-10 minutes have high risk of continuing.

Early treatment improved outcomes.

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11
Q

What meds in what order?

A
  1. Benzo x 2
  2. Fosphenytoin, phenytoin or phenobarbital
  3. Fosphenytoin, phenytoin or phenobarbital
    +/- paraldehyde if no IV
  4. RSI: midazolam infusion
  5. Thiopental/pentobarbital
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12
Q

Why does treatment fail?

A

Inadequate dose of benzo
Treating with > 2 benzo
Delay in second line treatment
Delay in RSI

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13
Q

What do you do if BG

A

5ml/kg 10% dextrose

0.5 g/kg

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14
Q

When do you recheck BG post bolus in hypoglycemia?

A

3-5 minutes

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15
Q

What are some general side effects of AEDs?

A

Loss of airway reflexes
Hypotension
Respiratory depression
Cardiac arrhythmia

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16
Q

How effective are benzos at stopping seizures?

A

70-85%
Especially if given within 20 minutes

Buccal: 75%
PR: 59%
Intranasal: 88%
IV: 92%

17
Q

Are the repeat doses of benzo as effective as the first?

A

No.

1st 85%
Repeat 17%

18
Q

What is the preferred second line medication?

A

Fosphenytion/phenytoin.

Why: less respiratory depression and altered level of consciousness than phenobarbital

19
Q

What are your options for second line meds if there is no IV?

A

IM fosphenytoin
IO phenytoin
PR paraldehyde

NB the evidence for safety and efficacy of IO phenytoin or phenobarbital is scant

20
Q

What is the dose of phenytoin?

Any special administration

A

20 mg/kg

Put it in NS
Over 20 minutes

It has a high PH and if it extravasates and causes severe irritation: purple glove syndrome!

21
Q

What is special about fosphenytoin and what’s the dose?

A

Pro drug

To avoid purple glove syndrome.

20mg/kg

22
Q

Side effects of phenytoin and fosphenytoin ?

A

Cardiac Arrhythmias, bradycardia, hypotension

23
Q

What’s the dose of phenobarbital?

Anything special?

A

20 mg/kg

Good for babies.

SE respiratory depression, sedation and hypotension

Similar MOA as benzos - so refractory seizures don’t respond.

24
Q

Why is paraldehyde only given rectally?

A

Because of side effects of IM and IV: cyanosis, cough, hypotension and pulmonary oedema.

25
Q

What is the dose of paraldehyde?

A

0.4 ml/kg PR

26
Q

Any special meds for CSE?

A

Sodium valproate 30 mg/kg
Less SE especially resp or CVS

Pyridoxine for kids

27
Q

Does a normal CT rule out increased ICP?

A

No

28
Q

Who do you refer to a neurologist?

A

CSE: and no prior history of epilepsy, even febrile

29
Q

How do you manage refractory CSE?

A

Midazolam infusion: loading 0.15 mg/kg then infusion to a maximum of 24 ug/kg/min
SE hypotension.

Barbiturates (thiopental or pentobarbital):
T 2 mg/kg then 2 mg/kg/h
Once controlled x 48 hours decrease 25% q3h
P 10 mg/kg then 1mg/kg/h

Propofol, topiramate, levetiracetam

30
Q

What is the definition of CSE?

A
  • continuous generalised tonic-clinic seizure activity with LOC for longer than 30 minutes
  • two or more discrete seizures without a return to baseline mental status

CPS: Acute care Committee (4 decks)

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