Status Epilepticus

Question 1

What is Generalized convulsive Status Epilepticus

Answer 1

Any recurrent or continuous seizure activity lasting longer than 30

Question 2

Does a patient with a GCSE regain baseline mental status?

Answer 2

No

Question 3

What occurs during Phase I of GCSE seizure?

Answer 3

1. Marked increase in epinephrine, norepinephrine, steroid concentrations
2. Muscle contractions and hypoxia

Question 4

What occurs during phase II of GCSE seizures

Answer 4

1. Decompensation of pt
2. Hypotensive with compromised Cerebral Blood flow
3. Decrease in Serum glucose
4. Hyperthermia, respiratory deterioration, hypoxia

Question 5

1st line treatment for Impending GCSE?

Answer 5

Lorazepam

Question 6

1st line treatments for Established GCSE (30-60 min phase 2)

Answer 6

Hydantoins

- phenytoin and fosphenytoin

Question 7

First line treatments for Refractory GCSE (>120/phase 3)

Answer 7

1. Anesthetic doses of Midazolam
2. Pentobarbital
3. Propofol

Question 8

Treatments for Super-refractory GCSE (>24 hours/ phase 4)

Answer 8

1. Ketamine
2. Hypothermia
3. Lidocaine
   Topiramate
4. Inhaled anesthetics
5. Immunomodulating therapy
6. Ketogenic
7. Vagal nerve stimulation

Question 9

What are the different delivery options for Midazolam?

Answer 9

1. Buccal- inside their cheek
2. Intranasal
3. IV and IM