Status Epilepticus Flashcards
Generalized Convulsive Status Epilepticus
recurrent or continuous seizure activity lasting longer than 30 minutes
does NOT regain baseline mental status
life threatening emergency
**any seizure that does not stop within 5 minutes should be aggressively treated as an impending SE
Seizure: pathophysiology
imbalance between excitatory (glutamate) and inhibitory (GABA) neurotransmission
sustained depolarization can result in neuronal death
Seizure: early (0-30 minutes)
marked inc in plasma epinephrine, norepinephrine, steroid concentrations (HTN, tachycardia, cardiac arrhythmias)
muscle contractions and hypoxia (acidosis, hypotension, shock, rhabdomyolysis, secondary hyperkalemia, acute tubular necrosis)
Seizure: later (30+ minutes)
decompensation
hypotensive w/ compromised cerebral blood flow
serum glucose (N or dec)
hyperthermia, respiratory deterioration, hypoxia, ventilatory failure
Impending GCSE: treatment
0-30 min
benzodiazepines:
lorazepam
midazolam (IM, IN, buccal)
diazepam (rectal - caregiver option)
Established GCSE: treatment
30-60 minutes
first line: hydantoins
second line: phenobarbital, valproate
third line: lacosamide, levetiracetam
Hydantoin
phenytoin, fosphenytoin
long acting anticonvulsants
given concurrently w/ benzodiazepines
Refractory GCSE
when seizure is not controlled by 2 anticonvulsants
Refractory GCSE: treatment
> 120 minutes
anesthetic doses of midazolam
pentobarbital
propofol
Super Refractory GCSE: treament
> 24 hours
ketamine hypothermia lidocaine topiramate inhaled anesthetic immunomodulating therapy ketogenic diet vagal nerve stimulation
Laboratory studies to evaluate for underlying cause
serum glucose, rapid finger stick glucose
serum electrolytes, Ca, Mg
ABG and pH
CBC
urine and blood toxicology
serum antiseizure drug levels
Midazolam: delivery options
buccal (directly into bloodstream)
intranasal
IV or IM (ambulatory or emergency)
**swallowing NOT recommended - not absorbed well through the stomach (ineffective)
