Status epilepticus

Question 1

Define status epilepticus?

Answer 1

Continuous seizure activity for 5 minutes or more without return of consciousness

OR
Recurrent seizures (2 or more) without an intervening period of neurological recovery

Question 2

Describe your initial assessment and management of an acutely unwell patient.

Answer 2

A: check airway patent, turn on side, airway manoeuvres, airway adjuncts

B: RR, sats, auscultate, give high flow oxygen

C: pulse, BP, CRT, establish IV access, fluid bolus

D: AVPU, pupils, BMs

E: whole body examination, temperature, warm patient

Question 3

How do you give high flow oxygen?

Answer 3

15L

Non-rebreathe mask

Question 4

A patient on the wards has a seizure.

How long before you give drugs to try and stop it?

If they don’t have IV access what would you give?

If they did have IV access what would you give?

Answer 4

5 minutes

If no IV access:
Rectal diazepam 10-20mg
(Buccal midazolam 10mg)

If IV access:
IV lorazepam usually 4mg

Question 5

What is an adverse effect of lorazepam that you need to look out for?

Answer 5

Respiratory depression

Question 6

A patient is having a seizure. 5 minutes after it started you gave IV lorazepam.

How long should you wait before intervening again?

Answer 6

After the first lorazepam, wait 10 minutes before giving another 4mg dose

Question 7

A patient is having a seizure. You’ve given 2 doses of lorazepam and they’re still fitting. What should you do next?

Answer 7

Start a phenytoin infusion

15-18mg/kg at a rate of 50mg/min

UNLESS she’s already taking it.

In that case you should give Keppra (levetiracetam)

Also would probably be a good plan to call an anaesthetist now

Question 8

What’s the proper name for Keppra

Answer 8

Levetiracetam

An anti-epileptic

Question 9

What will the anaesthetist do if you call them to a status epilepticus patient?

Answer 9

They’ll give phenobarbital

Can also do a RSI if necessary

Question 10

What are some causes of status epilepticus?

Answer 10

Trauma
Meningitis / encephalitis
Haemorrhage
SLE
DKA
Raised K, Na, glucose
Tuberous sclerosis
Epilepsy
Drugs

Question 11

What are some medical complications of status epilepticus?

Answer 11

Respiratory arrest
Hypoxia
Raised ICP
Hypoglycaemia
Rhabdomyolysis
Hyperpyrexia
Death

Question 12

What might you see on an ABG of a patient with status epilepticus?

Answer 12

Hypoxia
Hypoglycaemia
High lactate
Metabolic acidosis (from the raised lactate)