Status Epilepticus

Question 1

What is this a presentation of?
Seizures lasting for >5 minutes or repeated seizures without intervening recovery (most self-terminate within 3 minutes).

Answer 1

Status epilepticus

Question 2

At what point in status epilepticus may damage ensue if the seizure if left untreated?

Answer 2

After 30 minutes

Question 3

How can you identify a non-convulsive status epilepticus seizure?

Answer 3

Look for subtle eye/lid movement

Question 4

What is the emergency medication management for status epilepticus?

Answer 4

1. Time seizure, intervene after 5 minutes.
2. IV lorazepam 4mg (2mg over 1 minute)
3. Wait 10 minutes, if no response try again, wait 10 minutes (maximum 2 doses of BZDs).
4. Then valproate 40mg/kg or levetiracetam 60mg/kg or phenytoin infusion 20mg/kg
5. Use 10mg buccal midazolam if easier and no IV access and they are conscious (focal)

Question 5

What are the accessory parts of status epilepticus management (non-pharmaceutical)?

Answer 5

1. Protect patient, remove obstacles, padded bed rails.
2. Do not restrain, oxygen mask, cushion.
3. Obs and crash trolley
4. Recovery position after seizure
5. Suction and Guedel airway
6. ABG, glucose, U&Es, bone profile, FBC, AED drug levels urine toxicology, CXR for aspiration.

Question 6

What is an important differential to rule out in pregnancy if having a seizure?

Answer 6

Eclampsia