Repeated or cluster seziures, prolonged seizures, status epilepticus & febrile convulsions Flashcards
define repeated or cluster seziures
typically 3 or more self-terminating seizures in 24 hours
define prolonged convulsive seizures
a seizure that continues for more than 2 minutes longer than the patient’s usual seizure
what is convulsive status epilepticus
a seizure that lasts for 5 minutes or more
Repeated or cluster seizures, prolonged seizures, and status epilepticus should be managed as …
a medical emergency
what to do if a pt has repeated or cluster seizures, or prolonged convulsive seizures
- follow their individualised emergency management plan, if immediately availavle
- if not available, consider urgently treating with BZPN (e.g. clobazam, midazolam)
what to do for convulsive seizures that continue for 5 mins or more
follow recommendations for convulsive status epilepticus
if there is a concern that repeated or cluster seizures, or prolonged seizures (convulsive or non-convulsive) may recur, what should be agreed with the pt
an emergency management plan should be agreed with the patient if they do not have one already.
immediate measures to manage status epilepticus (4)
positioning the patient to avoid injury
supporting respiration including the provision of oxygen
maintaining blood pressure
correction of any hypoglycaemia
what to consider in consulsive status epilepticus if alcohol abuse suspected
parenteral thiamine
what to give if convulsive status epilepticus is caused by pyridoxine deficiency
give pryidoxine HCl
treatment of convulsive status epilepticus
- follow pt individualised emergency management plan if immediately available
- if not available, treat pt urgently with buccal midazolam or rectal diazepam in the community
- if IV acccess and resuscitation facilities are immediately available, can use IV lorazepam
when can you use IV lorazepam for treatment of convulsive status epilepticus
If intravenous access and resuscitation facilities are immediately available
status epilepticus - treatment is follow indivualised emergency plan; if not available then urgently treat with buccal midazolam or rectal diazepam in the community, or IV lorazepam if intravenous access and resuscitation facilities are immediately available.
If there is no response to first dose of BZDPN, what do you do?
call emergency services in community or seek expert advice in hospital
continue to follow pt plan if available OR give 2nd dose of BZDPN if seizure does not stop within 5-10 mins of first dose
convulsive status epilepticus - what to do if there is no response to two doses of BZDPN
- 2nd line treatment options include levet, phenytoin, or SV
- if it does not respond to a second line treatment, consider alternative 2nd line option under expert advise
- under expert advice, if 2nd line treatment options unsuccessul, 3rd line may include phenobarbital or GA
if there is concern that status epilepticus may recur, the following needs to be agreed
an emergency management plan should be agreed with the patient if they do not have one already