Status epilepticus–recognizing and planning initial management

Question 1

What are the 2 clinical criteria defining status epilepticus?

Answer 1

1. A single seizure that lasts longer than 5 minutes, or
2. Frequent seizures with no interictal return to the patient’s clinical baseline at 5 minutes.

Question 2

What can happen if status epilepticus lasts greater than or equal to 30 minutes?

Answer 2

Patient can suffer long-term neurologic consequences, such as neuronal injuries, neuronal network changes, or even neuronal death.

Question 3

When taking an urgent history for patient in status epilepticus what are some of the items that will be helpful?

Answer 3

Any prehospital antiseizure medications that were given
Prior history of seizures
Possible triggers for seizure (fever, trauma, changes in medications, toxin exposures)
Current medications
History of antiseizure medications used
Which antiseizure medications helped previously
Other active medication issues or diagnosis (hypoglycemia or hyponatremia)
Medical allergies

Question 4

What should be done first before a focused physical exam is obtained in a person with status epilepticus?

Answer 4

Patient’s airway, breathing, circulation and vital signs should be assessed first then assess for
Signs of head trauma
Signs of sepsis or meningitis: Fever, rash, poor perfusion, etc.
Characteristics of the seizure

Question 5

In a patient with status epilepticus what are some of the steps for maintaining an airway?

Answer 5

Airway is maintained through positioning, jaw thrust, or placing a nasopharyngeal or oropharyngeal airway. A Yankauer should be used to suction any secretions and be prepared for possible emesis.

Question 6

When should 100% oxygen be given to a patient in status epilepticus?

Answer 6

In a patient with status should be placed on 100% oxygen and oxygen saturation should be monitored with pulse oximetry.

Question 7

What are the 5 criteria for rapid sequence endotracheal intubation with mechanical ventilation for patient with status epilepticus?

Answer 7

And airway that is no longer able to be maintained
Inadequate ventilation
Apnea
Hypoxemia
30 minutes of seizure activity

Question 8

In a patient with status epilepticus if IV access cannot be obtained within 5 minutes what are other routes for giving antiseizure medication?

Answer 8

Alternative routes include rectal, intranasal, intramuscular, or intraosseous.

Question 9

What labs should be obtained and the patient with status epilepticus?

Answer 9

Plasma glucose and a rapid fingerstick glucose, treat hypoglycemia before antiseizure meds
Chemistries including calcium, correct hyponatremia and other electrolyte disorders while also treating seizures.
Antiseizure medication levels if patient is on any meds
Urine and blood toxicology screens for suspected poisoning or substance abuse
Qualitative pregnancy test in post menarchal females.

Question 10

When should an urgent portable EEG be obtained?

Answer 10

In any patient suspected of having subclinical seizures or status epilepticus.

Question 11

Before starting antiseizure medicines what should be assessed and corrected first?

Answer 11

Hypoglycemia, Before antiseizure medicines were administered

Question 12

Should electrolyte abnormalities and antiseizure medicines be given simultaneously in a person in status epilepticus

Answer 12

Yes that should be corrected simultaneously

Question 13

What medicines can be given to a patient in status epilepticus over 4 weeks of age?

Answer 13

1. benzodiazepines
2. long-acting, nonbenzodiazepine medications
3. Continuous infusion of midazolam or phenobarbital

Question 14

What benzodiazepines should be given immediately and repeated after 10 minutes if needed?

Answer 14

Lorazepam, diazepam, or midazolam

Question 15

What long-acting, not in benzodiazepine medications can be given if the second dose of a benzodiazepine was ineffective?

Answer 15

Levetiracetam, phenytoin, fosphenytoin, or valproic acid

Question 16

When should continuous infusion of midazolam or phenobarbital be given?

Answer 16

If the patient is still seizing after 30 minutes, 2 benzodiazepine doses, and 1 none benzodiazepine antiseizure medication have not worked.