Status epilepticus resident survival guide: Difference between revisions
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'''Start anesthesia (reduce the doses after 2-3 days):'''<br> | '''Start anesthesia (reduce the doses after 2-3 days):'''<br> | ||
❑ [[Midazolam]] (0.1-0.2 mg/kg bolus, then 0.05-0.5 mg/kg/hour) titrated to effect<br> | ❑ [[Midazolam]] (0.1-0.2 mg/kg bolus, then 0.05-0.5 mg/kg/hour) titrated to effect<br> | ||
OR | OR<br> | ||
[[Thiopental]] (3-5 mg/kg bolus, then 3-5 mg/kg/hour) titrated to effect<br> | ❑ [[Thiopental]] (3-5 mg/kg bolus, then 3-5 mg/kg/hour) titrated to effect<br> | ||
OR | OR<br> | ||
[[Propofol]] (1-2 mg/kg bolus, then 2-10 mg/kg/hour) titrated to effect<br> | ❑ [[Propofol]] (1-2 mg/kg bolus, then 2-10 mg/kg/hour) titrated to effect<br> | ||
---- | ---- | ||
'''Ensure full intensive care support'''<br> | '''Ensure full intensive care support'''<br> |
Revision as of 18:09, 18 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]; Rim Halaby, M.D. [3]
Definition
Status epilepticus is defined as a seizure persisting longer than 5 minutes or the occurrence of two or more episodes of seizures within one hour without returning to the baseline level of consciousness between the seizures.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Status epilepticus is a life threatening condition by itself because it results in serious immediate and long term morbidity and mortality if the convulsive seize is not terminated by 30 minutes; therefore, treatment is required urgently.
Common Causes
- Brain trauma
- Cerebrovascular disorders
- Electrolytes abnormalities
- Hypoglycemia
- Infections
- Low antiepileptic drug levels in patients with epilepsy[1]
Management
Shown below is an algorithm summarizing the approach to status epilepticus. The goal of the treatment is to stop the seizure as soon as possible; therefore, begin the general measures and administer the antiepileptic medications (AED) SIMULTANEOUSLY.
Characterize the symptoms: ❑ Aura (altered vision and/or hearing), AND/OR ❑ Tonic phase with muscle spasms, AND/OR ❑ Rapid jerky movement, AND/OR ❑ Uprolling of eyes, AND/OR ❑ Tongue bite, AND/OR ❑ Incontinence | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
General measures (Emergency): Begin initial care: ❑ Turn patient to side ❑ Secure airway ❑ Assess respiratory and cardiac functions ❑ Administer high concentration O2 ❑ Establish IV access ❑ Institute regular monitoring for pulse, blood pressure, temperature ❑ ECG monitoring ❑ Check glucose level, and correct hypoglycemia if present (Emergency) Order labs: Consider vitamin deficiencies: Consider alternative diagnosis: Treat acidosis if severe | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Administer AED (Emergency): | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recurrent or ongoing seizure 10 min after onset? (Emergency) ❑ Repeat the previous regimen only ONCE | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recurrent or ongoing seizure 30 mins after onset? (Emergency) ❑ IV phenytoin (15-18 mg/kg at 50 mg/min): Slow IV infusion, IM is not recommended, monitor ECG during the infusion OR ❑ IV fosphenytoin (15-20 mg phenytoin equivalents (PE)/kg at 50-100 mg PE/min): monitor ECG during the infusion OR ❑ IV phenobarbital (10-15 mg/kg at 100 mg/min) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ongoing seizure 60 mins after onset? (Emergency) Start anesthesia (reduce the doses after 2-3 days): Ensure full intensive care support ❑ ICU admission and continuous monitoring | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from the 2012 National Institute for Health and Care Excellence (NICE) clinical guidelines.
Do's
Dont's
References
- ↑ Trinka E, Höfler J, Zerbs A (2012). "Causes of status epilepticus". Epilepsia. 53 Suppl 4: 127–38. doi:10.1111/j.1528-1167.2012.03622.x. PMID 22946730.