Status epilepticus Flashcards
What is status epilepticus?
Continuous seizure activity that fails to self-terminate >5mins (used to be >30mins)
or recurs without complete recovery between
- RISK NEUROLOGICAL DAMAGE
what can cause status epilepticus in paeds?
- febrile convulsion,
- known epilepsy + acute illness,
- meningoencephalitis,
- metabolic/electrolyte abnormality,
- drugs/intoxication/poisoning,
- ICH,
- trauma
How do you Rx status?
ABCDE, cannulate, oxygen, vitals (paediatric doses)
&
oh my lord phone the anaesthetist
- 0mins: Oxygen (ABCDE approach)
- 5mins: Midazolam (buccal; or rectal diazepam; or IV lorazepam 0.1mg/kg)
- 15mins: Lorazepam IV 0.1mg/kg, senior help
- 25mins: Phenytoin IVI over 20mins
- 45mins: Anaesthetist - rapid sequence induction (RSI) with propofol, thiopental sodium or midazolam
How is lorazepam given?
- slow bolus into large vein;
- if no response within 10mins give 2nd dose (beware respiratory arrest),
- rectal route an alternative for diazepam if IV access is difficult
- Buccal midazolam is an easier oral alternative
What should you beware of with phenytoin infusion (if after 20m the seizure hasnt stopped give phenytoin IVI over 20m)
beware low BP
& dont use if bradycardic or heart block
(is an Na+ channel antagonist)
Once the seizure is under control either with oh my lord or phone then give baseline level of benzos and wean off. What do you use and what should be considered?
Diazepam infusion:
- until seizures respond
- –>(close monitoring, especially respiratory function is vital)
- if they remain unresponsive to this are they pseudoseizures?
Why would you give dexamethasone in status epilepticus?
If vasculitis/cerebral oedema (tumour) possible
What do you give for refractory status e.g. >45mins
general anaesthesia
(rapid sequence induction (RSI) with propofol, thiopental sodium or midazolam)
