status epilepticu

Question 1

what are the 2 types of status epilepticus? explain each one

Answer 1

1. convulsive status epilepticus: convulsive seizure which continues for prolonged period [over 5 mins] or when convulsive seizures occur one after the other with no recovery in between. emergency and requires medical attention
2. non convulsive status epilepticus: less common and less urgent

Question 2

what is the initial management of convulsive status epilepticus

Answer 2

1. position pt to avoid injury
2. give oxygen
3. maintain blood pressure and correct any hypoglycaemia
4. give parenteral thiamine if alcohol abuse suspected
5. give pyridoxine [vitamin b6] if there is a deficiency
6. give iv lorazepam if seizure lasts longer than 5 mins. repeated once after 10 mins if seizure reoccurs or fails to respond.
7. can give iv diazepam but side effects [blood clots]. can use an emulsion formulation to avoid s/e
8. im diazepam and suppositories absorption is too slow.

Question 3

if a patient is experiencing status epilepticus, but there are no facilities for resuscitation, what can be offered to the pt?
what to offer if these options fail?

Answer 3

• diazepam can be given rectally OR
• midazolam can be given oromucosal solution and given in the buccal cavity

if this does not work…

• give phenytoin sodium, fosphenytoin sodium or phenobarbital sodium. contact intensive care if seizures continue.

Question 4

which anaesthetics can be used in intensive care for status epilepticus management? [3]

Answer 4

thiopental sodium
propofol
midazolam

Question 5

what is the management of non-convulsive status epilepticus?

Answer 5

1. treat with oral anti-epileptics if urgency is necessary.

2. if this fails [pt has lost all awareness], treat in the same way as convulsive status epilepticus