Status_Epilepticus_Flashcards
What is the first step in the management of status epilepticus at 0 minutes?
Secure airway.
What should be checked during the initial assessment at 0 minutes?
Check ABC, high flow Oxygen2 if available, check blood glucose, confirm clinically that it is an epileptic seizure.
What is the second step in the management of status epilepticus at 5 minutes?
If IV access, IV lorazepam. If NO immediate IV access: Buccal midazolam, Rectal diazepam.
What should be administered if IV access is available at 5 minutes?
IV lorazepam.
What should be administered if there is no immediate IV access at 5 minutes?
Buccal midazolam or Rectal diazepam.
What is the third step in the management of status epilepticus at 15 minutes?
If no response, give a second dose of IV lorazepam, call for senior help, start to prepare phenytoin for step 4, re-confirm it is an epileptic seizure.
What should be done if there is no response to the first dose of IV lorazepam at 15 minutes?
Give a second dose of IV lorazepam.
What preparations should be made for step 4 if there is no response at 15 minutes?
Call for senior help, start to prepare phenytoin, re-confirm it is an epileptic seizure.
What is the fourth step in the management of status epilepticus at 25 minutes?
Seek senior anaesthetist / inform ICU, Phenytoin 20 mg/kg by intravenous infusion over 20 mins or (if on regular phenytoin): Phenobarbital 20 mg/kg intravenously over 5 mins, Consider rectal paraldehyde 0.8 ml/kg.
Who should be sought for assistance at 25 minutes?
Seek senior anaesthetist / inform ICU.
What is the recommended dose of phenytoin at 25 minutes?
Phenytoin 20 mg/kg by intravenous infusion over 20 mins.
What is the alternative to phenytoin if the patient is on regular phenytoin at 25 minutes?
Phenobarbital 20 mg/kg intravenously over 5 mins.
What is the fifth step in the management of status epilepticus at 45 minutes?
Rapid sequence induction of anaesthesia using thiopental sodium.
What should be considered if vasculitis or cerebral oedema is possible?
Consider dexamethasone.
What reversible causes should be treated if identified?
Treat reversible causes if identified (e.g. thiamine if malnourished or glucose if hypoglycaemic).
