Status epilepticus resident survival guide: Difference between revisions
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* [[Electrolyte|Electrolytes abnormalities]] | * [[Electrolyte|Electrolytes abnormalities]] | ||
* [[Hypoglycemia]] | * [[Hypoglycemia]] | ||
* [[Infection]]s | * [[Infection]]s | ||
* [[Epilepsy|Low antiepileptic drug levels in patients with epilepsy]] | * [[Epilepsy|Low antiepileptic drug levels in patients with epilepsy]]<ref name="pmid22946730">{{cite journal| author=Trinka E, Höfler J, Zerbs A| title=Causes of status epilepticus. | journal=Epilepsia | year= 2012 | volume= 53 Suppl 4 | issue= | pages= 127-38 | pmid=22946730 | doi=10.1111/j.1528-1167.2012.03622.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22946730 }} </ref> | ||
==Management== | ==Management== |
Revision as of 17:29, 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 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.
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 ❑ Tounge 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 (Urgent) Order labs: Consider vitamin deficiencies: Consider the possibility of non-epileptic status Treat acidosis if severe | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Administer AED (Emergency): | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recurrent or ongoing seizure 10 min after onset? (Urgent) ❑ Repeat the previous regimen only ONCE | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recurrent or ongoing seizure 30 mins after onset? (Urgent) ❑ 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? (Urgent) ❑ Intubate and ensure full intensive care support ❑ Anesthetize with midazolam (0.1-0.2 mg/kg bolus, then 0.05-0.5 mg/kg/hour), OR thiopental (3-5 mg/kg bolus, then 3-5 mg/kg/hour, OR propofol (1-2 mg/kg bolus, then 2-10 mg/kg/hour) titrated to effect; reduce the dose after 2-3 days as fat stores are saturated ❑ ICU admission | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.