Status Epilepticus

Question 1

What is status epilepticus?

Answer 1

Seizures lasting > 30min or repeated seizures without intervening consciousness lasting >30min

Question 2

Management of status epilepticus?

Answer 2

Airway:
Secure
High flow oxygen
IV access and take blood: U&E, LFT, FBC< glucose, calcium, anticonvulsant levels

At 5mins:

IV bolus of Lorazepam 0.1mg/kg (usually 4mg)

Buccal midazolam if no IV access:
10y+ = 10mg
5-10y = 7.5mg
1-5y =5mg

Squirt half volume between lower gum and cheek on each side

Give 2nd dose of IV lorazepam if no response after 10-20 minutes

Thiamine 250mg IV if alcoholism or malnourishment suspected
Glucose 50ml 50% IV unless glucose is normal
Correct hypotension with fluids

Question 3

if seizures continue after lorazepam second dose?What should you do

Answer 3

Penytoin infusion 15mg/kg IVI
at rate of 50mg/min
Monitor ECG and BP

100mg/6-8h is maintenance dose

Seek ICU help
- General anaesthesia rapid sequence induction with thiopental

Question 4

What dose of lorazepam?

Answer 4

0.1mg/kg (usually 4mg for adult)

Question 5

What does of rectal diazepam?

Answer 5

For Neonate
1.25–2.5 mg, then 1.25–2.5 mg after 10 minutes if required.

For Child 1 month–1 year
5 mg, then 5 mg after 10 minutes if required.

For Child 2–11 years
5–10 mg, then 5–10 mg after 10 minutes if required.

For Child 12–17 years
10–20 mg, then 10–20 mg after 10 minutes if required.

For Adult
10–20 mg, then 10–20 mg after 10–15 minutes if required.