Status Epilepticus Flashcards

1
Q

Generalized Convulsive Status Epilepticus

A

recurrent or continuous seizure activity lasting longer than 30 minutes

does NOT regain baseline mental status

life threatening emergency

**any seizure that does not stop within 5 minutes should be aggressively treated as an impending SE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Seizure: pathophysiology

A

imbalance between excitatory (glutamate) and inhibitory (GABA) neurotransmission

sustained depolarization can result in neuronal death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Seizure: early (0-30 minutes)

A

marked inc in plasma epinephrine, norepinephrine, steroid concentrations (HTN, tachycardia, cardiac arrhythmias)

muscle contractions and hypoxia (acidosis, hypotension, shock, rhabdomyolysis, secondary hyperkalemia, acute tubular necrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Seizure: later (30+ minutes)

A

decompensation

hypotensive w/ compromised cerebral blood flow

serum glucose (N or dec)

hyperthermia, respiratory deterioration, hypoxia, ventilatory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Impending GCSE: treatment

A

0-30 min

benzodiazepines:
lorazepam
midazolam (IM, IN, buccal)
diazepam (rectal - caregiver option)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Established GCSE: treatment

A

30-60 minutes

first line: hydantoins

second line: phenobarbital, valproate

third line: lacosamide, levetiracetam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hydantoin

A

phenytoin, fosphenytoin

long acting anticonvulsants

given concurrently w/ benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Refractory GCSE

A

when seizure is not controlled by 2 anticonvulsants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Refractory GCSE: treatment

A

> 120 minutes

anesthetic doses of midazolam

pentobarbital

propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Super Refractory GCSE: treament

A

> 24 hours

ketamine
hypothermia
lidocaine
topiramate
inhaled anesthetic
immunomodulating therapy
ketogenic diet
vagal nerve stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Laboratory studies to evaluate for underlying cause

A

serum glucose, rapid finger stick glucose

serum electrolytes, Ca, Mg

ABG and pH

CBC

urine and blood toxicology

serum antiseizure drug levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Midazolam: delivery options

A

buccal (directly into bloodstream)

intranasal

IV or IM (ambulatory or emergency)

**swallowing NOT recommended - not absorbed well through the stomach (ineffective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly