Status epilepticus

Question 1

A 24 year old woman is admitted to hospital with suspected viral encephalitis and is commenced on high-dose aciclovir. On the first night of her hospitalisation she has a generalised seizure which is persisting for more than 10 minutes. How would you manage her?

Answer 1

Impression
Given this seizure has persisted for >5 minutes this meets criteria for status epilepticus, a medical emergency demanding emergent treatment and management.

Priorities

• conduct A to E assessment
• initiate supportive measures to prevent complications
• definitively treat status and the underlying viral encephalitis

Question 2

Status epilepticus - Management

Answer 2

Management
Would take an A to E approach to assessment whilst concurrently addressing key treatment priorities.
- Start MERT call, escalate to senior colleagues +/- ICU involvement

A - patent, maintaining. airway adjuncts as req
B - RR, sats, ongoing monitoring. supplemental as required. Consider intubation if refractory
C - 2xIV access, bloods (VBG, FBC, UEC), ECG monitoring
start status pathway:
- benzo (midazolam)
- anti epileptic (sodium valproate, phenytoin, OR Kepra but limited evidence)
- ICU transfer if still refractory
D - GCS
E - secondary survey
F - Fluids

Want to limit risk of patient injuring themselves during seizure. also present complications of seizure including;

• aspiration
• trauma
• CNS injury, hypoxia
• hyperthermia
• rhabdomyolysis
• ICU involvement
• Neurology involvement