Status Epilepticus Flashcards
What is status epilepticus defined as?
When seizure lasts more than 5 minutes
2 or more seizures without full recovery within 30 minutes
If a status epilepticus lasts more than 30 minutes, what can occur?
Permanent brain damage
Death
How is it managed?
ABCDE
Secure airway
Give oxygen
IV bolus lorazepam 4mg - give second dose if no response after 10-20 minutes
Thiamine 250mg (Pabrinex) if alcoholism or malnourishment suspected
Glucose 50mL 50% IV unless glucose known to be normal
Correct hypotension with fluids
If seizures continue: IV infusion phenytoin 20mg/kg at max rate 50mg/min
If patient is not in a hospital and there is no IV access, what can be given instead of IV lorazepam?
Buccal midazolam or if not available rectal diazepam
When giving IV lorazepam, what should you be aware of at the end of the injection?
Respiratory arrest - need full resuscitation facilities available for all IV benzodiazepines
When should phenytoin infusion not be used?
Heart block
Bradycardia
What monitoring does phenytoin require?
BP
ECG
If seizures continue after phenytoin infusion, what should be done?
ICU help
Paralysis and anaesthesia e.g propofol infusion
Does status usually occur in those with known epilepsy?
Yes
If status epilepticus is the first seizure presentation the chance of what is high?
Structural brain lesion >50%
What investigations should be done?
Glucose level ABG FBC, LFT, urea and electrolytes Clotting AED levels Toxicology screen Blood and urine culture LP
What danger is there with prolonged seizures?
Hypoxic brain injury
What is a typical ABG pattern?
Acidotic
Reduced pO2
Elevated lactate
What imaging should be done (once patient stable)
CT head
