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B - Paediatrics MANAGEMENT > Status Epilepticus > Flashcards

Status Epilepticus Flashcards

1
Q

What is status epilepticus (SE)?

A

Continuous seizures lasting more than 5 minutes or intermittent seizures without full recovery over a period of 5 minutes

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2
Q

What is crucial in treating SE?

A

Terminating seizures as soon as possible

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3
Q

Why is early seizure termination important?

A

Longer seizure duration is associated with worse outcomes

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4
Q

How do prolonged seizures respond to treatment compared to short seizures?

A

They are more resistant to treatment

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5
Q

What causes seizures?

A

Rapid abnormal electrical discharges from cerebral neurones

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6
Q

How may seizures present clinically?

A

Involuntary alterations in consciousness and/or motor activity

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7
Q

What happens to facilitate SE?

A

Failure of normal factors that act to terminate atypical neuronal activity

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8
Q

What changes can lead to failure of seizure termination?

A
  • Changes in GABA receptor composition
  • Loss of benzodiazepine efficacy
  • Excessive glutamate excitation
  • Activation of drug resistance genes
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9
Q

What are prolonged seizures associated with?

A
  • Cerebral hypoxia, hypoglycaemia and hypercapnia

- Progressive lactic and respiratory acidosis

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10
Q

What can occur as a result of cerebral hypoxia and hypoglycaemia?

A

Cerebral metabolic needs may exceed the available oxygen and glucose

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11
Q

What will happen if the cerebral metabolic needs exceed available oxygen and glucose?

A

Potentially irreversible neuronal destruction

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12
Q

What can cause SE?

A
  • Meningitis
  • Head injury
  • Altered drug therapy in epileptic
  • Non-compliance in a known epileptic
  • Metabolic disturbances
  • ‘Febrile status’
  • Poisoning
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13
Q

What are the different types of SE?

A
  • Simple partial
  • Complex partial
  • Absence
  • Non-convulsive
  • Myoclonic
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14
Q

What blood tests should be performed on a person with SE?

A
  • Blood gases
  • Glucose
  • Renal and lifer functions
  • Calcium
  • Magnesium
  • FBC
  • Clotting
  • AED drug levels
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15
Q

What samples should be taken for future analysis in SE?

A
  • 5ml blood

- 50ml urine

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16
Q

If suspecting aspiration during seizure what should be performed?

A

CXR

17
Q

What are other investigations dependant on?

A

Clinical picture

18
Q

What additional investigations may be considered?

A
  • LP

- CT head

19
Q

What are the differentials for SE?

A

Psychogenic non-epileptic SE

20
Q

What should be done as soon as someone begins having a seizure?

A
  • Maintain airway
  • Give high flow oxygen
  • Check glucose
21
Q

What should be done if a seizure has not stopped after 5 minutes?

A
  • If IV access readily available give IV lorazepam

- If NOT, give buccal midazolam or rectal diazepam

22
Q

What should be done if a seizure has not stopped after 15 minutes?

A
  • IV lorazepam
  • Call senior help
  • Prepare phenytoin to confirm if epileptic seizure
23
Q

What should be done if a seizure has not stopped after 25 minutes?

A
  • Ensure senior help is present
  • Seek anaesthetic/ICU advice
  • Consider rectal paraldehyde
  • IV phenytoin over 20 mins or if on phenytoin give phenobarbitone IV over 5 mins
24
Q

What should be done if a seizure has not stopped after 45 minutes?

A

Rapid sequence induction of anaesthesia with thiopental with anaesthetist present

25
Q

What should be monitored in patients who have experienced status epilepticus?

A
  • Regular neuro obs
  • Pulse, BP and temp
  • ECG
  • Biochemistry
  • Blood gases
  • Clotting
  • Blood count
  • Drug levels
26
Q

What do patients undergoing SE require?

A

Full ITU facilities

27
Q

Who is responsible for the care of a patient with SE?

A

Neurologist and anaesthetist

28
Q

When is EEG monitoring required?

A

In patients with refractory SE

29
Q

What are the potential complications of SE?

A
  • Motor and cognitive sequelae

- Hippocampus sclerosis

30
Q

What can hippocampus sclerosis lead to?

A

Chronic recurrent and refractory complex partial seizures

B - Paediatrics MANAGEMENT (106 decks)

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