status epilepticus

Question 1

A child is seizing in the A:E department. What is the initial procedure?

Answer 1

A,BC and call for senior help. Gain IV access with two wide bore cannulas

Question 2

what is your priority investigation?

Answer 2

check the blood glucose rule out hypoglycemia.

Question 3

What medical treatment are you going to use?

Answer 3

benzodiazapam (IV)

Question 4

what if you cannot gain IV access?

Answer 4

go for buccal midazolam or rectal diazepam

Question 5

how long should you try for IV access?

Answer 5

10 minutes then go for intraosseous use lorazepam 0.1 mg/kg max of 4 mg

Question 6

what if the benzodiazepines fail to control the seizure?

Answer 6

use phenytoin and if that fails you are getting the anaesthetist to put the child under GA.

Question 7

what should you monitor at all times?

Answer 7

heart function!

Question 8

patient is stabilised what investigations are you goin to do?

Answer 8

CT brain
try to find a focus? 
FBC/CRP
blood culture 
CSF
VBG
U&E
LFT 
Ca
Mg
metabolic screen

Question 9

when should treatment be started in status epilepticus?

Answer 9

with in 10 minutes of tonic clonic activity

Question 10

definition of status epilepticus?

Answer 10

generalized tonic clonic movements lasting 30 minutes or more?

Question 11

what is the timeline for treatment?

Answer 11

first 10 minutes- lorazeopam 0.1 mg/kg 30-60 seconds next ten minutes give another dose of lorazepam, next 10 minutes (20minutes) call for senior help,. fosphenytoin 18mg/kg 
10 minutes 
phenobarbitone 20mg/kg
10 minutes 
refractory EEG ICU 
rapid sequence induction.