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AIP: Seizures > Status epilepticus > Flashcards

Status epilepticus Flashcards

1
Q

What are the initial steps in the acute management of seizure at onset? 5 key things

A
  1. START THE TIMER - timing up to 5 minutes as this becomes assumed status
  2. Put out crash call if patient has no history of seizures
  3. ask staff if patient known alcoholic or diabetic (?withdrawal ?hypo)
  4. ask to bring the crash trolley over - in case airway needed
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2
Q

What are the 3 key points in the A part of A→E assessment for an acute seizure (not yet status)?

A
  1. A: assess airway - can they talk (conscious?)
  2. if not then assess for other features of airway obstruction: see saw breathing, accessory muscle use, stridor/gargling, visible secretions in airway
  3. if airway not patent consider NPA
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3
Q

What are the 3 key parts of B of the A to E assessment for a seizure?

A
  1. monitor sats
  2. give O2 if needed
  3. ABG if sats low
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4
Q

What are the 5 key parts of C of the A to E assessment for a seizure?

A
  • Heart rate
  • Bloop pressure
  • Capillary refill
  • Give fluid bolus if hypotensive
  • ECG monitoring
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5
Q

What are the 4 key parts of D of the A to E assessment for a seizure?

A
  1. Measure blood glucose.
  2. If hypoglycaemic give 50ml of 20% glucose
  3. Measure temperature
  4. If known alcoholic give Pabrinex: two pairs of ampoules in 100mL of 0.9% saline
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6
Q

What are 2 key parts of the E part of A to E assessment for an acute seizure?

A
  1. Look for signs of head injury
  2. Look for any rashes suggesting infection
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7
Q

What should you be ready to treat when giving Pabrinex in known alcoholic patients?

A

anaphylaxis - it can occasionally cause this

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8
Q

What are the 2 key different types of seizures?

A
  1. focal - split into aware and impaired awareness
  2. generalised. motor or non-motor (absence)
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9
Q

What is the definition of status epilepticus?

A
  • continuous generalised seizure lasing >30 minutes or 2 or more seizures over 30min with incomplete resolution
  • often we time up to 5 minutes and this is assumed to be status epilepticus and start treating at this point
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10
Q

What are 4 stages of status epilepticus and the timings associated with them?

A
  1. Premonitory stage 0-10 minutes
  2. Early status 0-30 minutes
  3. Established status 0-60 minutes
  4. Refractory status 30-90 minutes
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11
Q

What are 3 key parts of the A-E assessment of status epilepticus?

A
  1. Airway adjunct
  2. Oxygen
  3. Check blood glucose
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12
Q

In the pre-hospital setting what are the first-line drugs given in status epilepticus?

A
  • Benzodiazepines: diazepam rectally 10-20mg
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13
Q

What is the first-line drug given in the hospital setting in status epilepticus?

A

lorazepam 4mg IV slowly into large vein

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14
Q

What are 2 alternatives to IV lorazepam in the hospital setting if IV access is not established?

A
  1. buccal midazolam 10mg
  2. rectal diazepam 10-20mg
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15
Q

After how long can IV lorazepam 4mg be repeated after the first dose?

A

10 min if seizures continue

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16
Q

How many times can you repeat buccal midazolam 10mg?

A

can give max twice

17
Q

How many times can you repeat rectal diazepam 10-20mg?

A

repeat up to total of 30mg

18
Q

If alcohol abuse or malnutrition is suspected in a patient in status, what should be given?

A

slow IVI thiamine in the form of Pabrinex: 2 pairs of ampoules in 100mg of 0.9% saline

19
Q

Why should you consider if the patient could be pregnant?

A

could be pregnancy-related fits i.e. eclampsia

20
Q

What is the management of eclampsia?

A

IV magnesium sulfate

21
Q

What are 8 bloods you may ask for as part of the management of status?

A
  1. Blood cultures
  2. FBC
  3. U+E
  4. Glucose
  5. Calcium and magnesium
  6. LFTs
  7. Clotting
  8. Drug levels / toxicology screen if poisoning/overdose suspected
22
Q

If seizures continue despite initial benzodiazepines, what are the next 2 key steps?

A
  1. Call ICU
  2. Consider use of phenytoin 20mg/kg IV up to max of 2g, at rate of 50mg/min with ECG monitoring
23
Q

How is phenytoin given in status?

A

20mg/kg IV, up to a max of 2g, at a rate of 50mg/min

24
Q

What is an alternative drug to phenytoin in status and how is it given?

A

fosphenytoin: 20mg/kg phenytoin equivalent IV, <150mg/min

25
Q

What must be done after 30 minutes of seizures?

A

contact ICU and proceed without delay to rapid sequence induction (RSI) ideally with thiopental and tracheal intubation, and continue anticonvulsant medication

26
Q

What induction agent should ideally be used for RSI in status epilepticus?

A

thiopental

27
Q

In addition to lorazepam in early status, what other medication should patients be given?

A

usual AED medication if already on treatment

28
Q

What is another anti-epiletic drug that can be given alongside or instead of phenytoin?

A

phenobarbital bolus 10-15mg/kg at a rate of 100mg/minute

29
Q

What are 2 other antiepileptics that can be used instead of phenytoin/fosphenytoin?

A
  1. valproate
  2. leviteracetam
30
Q

In what order should patients needing Pabrinex and glucose be given them and why?

A

pabrinex prior to glucose to avoid precipitation of Wernicke’s encephalopathy or Korsakoff’s

31
Q

At what point should you contact ICU?

A

if initial measures with benzodiazepines fail to manage status

32
Q

What are 4 things to do once a seizure has lasted for 30 minutes?

A
  1. Contact ICU
  2. Proceed without delay to rapid sequence induction (RSI) ideally with thiopental
  3. Tracheal intubation
  4. Continue anticonvulsant medication
33
Q

What are the 2 key electrolytes which, if deranged, can cause seizures?

A
  1. Calcium
  2. Sodium
34
Q

What is the level of care to which a foundation doctor can manage status before calling for help?

A

can give the first 2x IV lorazepam 10-15min apart

35
Q

If a patient is in status and their sats are dropping, which airways can be used?

A
  • nasopharyngeal airway
  • bag and mask
  • (unlikely to be able to give iGel or Guedel as jaw locked)
36
Q

What should you do immediately after a seizure resolves?

A

A to E assessment again

37
Q

What must you be careful of when inserting a nasopharyngeal airway in status epilepticus?

A

if get any resistance at all, don’t do it, change tack - bag and mask or get ITU (will need to do RSI to intubate)

38
Q

What is the best approach in terms of taking blood/performing an ABG in a patient with status epilepticus?

A

best to wait until after seizure finishes

AIP: Seizures (14 decks)

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