RRAPID: Status Epilepticus

Question 1

Definition? (2)

Answer 1

Seizures lasting > 5 mins

OR

2 or more with 5 mins without regaining consciousness

Question 2

Features?

Answer 2

Tonic-clonic seizure
Non-convulsive status is more difficult
EEG can be helpful to confirm the diagnosis

Question 3

Response (Airway)?

Answer 3

Maintain airway (consider recovery position)

Question 4

Response (Breathing)?

Answer 4

O2 15 L/min via a reservoir mask

Question 5

Response (Circulation)?

Answer 5

IV access
Bloods: FBC, U&E’s, LFT’s, calcium, magnesium, glucose
Blood cultures (if sepsis)

Question 6

Medication Mx? (more than 5 mins)

If seizure continue?

Answer 6

Lorazepam 2-4 mg IV or diazepam 10 mg PR or midazolam 10mg (buccal)
Repeat after 5 mins if necessary

Phenytoin 20mg/kg IV (max 2g) over 20 mins

Question 7

What needs to be monitored if on phenytoin?

Answer 7

ECG

BP

Question 8

If seizure continue after second line?

Answer 8

Anaesthetic sedation (call ICU)