Acute Seizures Flashcards Preview

Acute Management > Acute Seizures > Flashcards

Flashcards in Acute Seizures Deck (38):
1

 

 

What is the definition of status epilepticus?

 

Continuous seizures for 30 minutes or longer (or two or more seizures without recovery of consciousness between them over a similar period)

2

 

 

What is the risk of brain damage in someone having status epilepticus for the first time?

 

 

>50%

3

 

 

Do all those in status epilepticus have tonic-clonic seizures?

 

 

Primarily, but can also have absence status (continous, stuporous state), focal status and epilepsia patiralis continua (seizure activity in one part fo the body e.g. finger or limb)

4

 

 

If a patient was in status epilepticus and was pregnant, what might you consider as your differentials?

 

  • Eclampsia - following pre-eclampsia
  • Epilepsy - previously diagnosed or undiagnosed

5

 

 

If a patient was in status epilepticus and was pregnant, what investigations might you consider?

 

  • BP
  • Urine dipstick - protein

6

 

 

How would you initially manage someone in status epilepticus?

ABCDE

  • A - open, remove false teeth
  • B - 100% O2 + suction
  • C - IV access, BP, fluids
  • D - consider blood glucose
  • E - head injury?

7

 

 

When gaining IV access in someone in status epilepticus, what bloods would you want to take?

 

  • U+E's
  • LFTs
  • FBC
  • Glucose
  • Ca2+
  • Toxicology screen
  • Anticonvulsant levels
  • ABG/VBG
  • Consider CO levels

8

 

 

What initial investigations would you do in someone in status epilepticus?

 

  • Cap glucose
  • Bloods - FBC, U+E's, Ca2+, VBG, Anticonvulsant levels, clotting
  • ECG
  • Consider LP, BCs - infection
  • If cause unkown - Consider CT/MRI head/EEG 

9

 

 

What would you give in the first 10 minutes to attempt to terminate status epilepticus?

 

 

IV Lorazepam - 4mg; or IV Diazepam - 10 mg

10

 

 

If you were uable to gain IV access to give medications, how would you administer benzodiazepines in an attempt to terminate status epilepticus?

 

  • Buccal Midazolam - 10 mg adult, 7.5 mg age 5-10, 5mg age 1-5
  • Diazepam PR - 10-20mg

 

11

 

 

What dose of lorazepam would you initially give someone IV if they were in status epilepticus?

 

 

4mg

12

 

 

What dose would you initially consider giving someone of IV diazepam if they were in status epilpeticus?

 

 

10 mg IV diazepam

13

 

 

If there was no response to an initial dose of benzodiazepines (lorazepam/diazepam) after 10-20 minutes, what would you consider doing?

 

 

Give second dose of benzodiuazepines

14

 

 

If someone, after repeated benzodiazepine doses, was still in status epilepticus after 30 minutes, what would you consider giving them?

 

 

IV phenytoin

15

 

 

What dose of phenytoin would you consider giving to someone in status epilepticus?

 

 

 

 

15-18 mg/kg IV

16

 

 

What rate would you give IV phenytoin at in someone in status epilepticus?

 

 

50 mg/min

17

 

 

What monitoring would you do whilst giving someone in status epilpeticus phenytoin infusion?

 

  • ECG
  • BP

27

 

 

If, after 60-90 minutes, someone is still in status epilepticus following treatment with phenytoin and benzodiazepines, what would you consider doing?

 

 

Call anaesthetist/ITU physician - General anaesthesia (propofol) in ITU, intubation

28

 

 

What is the general rule for when to call an anaesthatist when managing someone in status epilepticus?

 

 

Never spend longer than 20 mins on someone in status without help from anaesthatist

29

 

 

When would you not use phenytoin to treat status epilepticus?

 

  • Bradycardia
  • Heart block

30

 

 

When would you be cautious using phenytoin in someone in status epilepticus?

 

 

Hypotension

31

 

 

What should you be wary of when giving someone IV benzodiazepines?

 

 

 

Respiratory arrest - during last part of injection

32

 

 

What monitoring would you perform in someone in status epilepticus?

 

  • Pulse oximetry
  • Cardiac Monitor

33

 

 

If you suspected a seizure was due to hypoglycaemia, what might you give in addition to standard treatment for status epilepticus?

 

 

50ml 50% glucose

34

 

 

What would you give in addition to standard treatment for status epilepticus in someone where you think alcohol abuse may be an issue/the cause?

 

 

IV Pabrinex

35

 

 

How would you correct hypotension in someone in status epilepticus?

 

 

Fluids

36

 

 

How long can the post-ictal period last following status epilepticus?

 

 

A few hours

37

 

 

What would you want to do once you have managed to terminate a status epilepticus?

 

  • Switch to oral drugs when possible
  • Find cause - History, mutli-system exam, investigations
  • Treat cause
  • Refer to neurology
  • Advise regarding driving and DVLA

38

 

 

What are common neurological causes of seizures?

 

  • Epilepsy
  • Brain tumour
  • Meningitis/encephalitis
  • Post-stroke
  • Head Trauma
  • Congenital abnormalities/hypoxic injury

39

 

 

What are metabolic causes of seizures?

 

  • Hypoglycaemia
  • Hyponatraemia
  • Hypocalcaemia
  • Hyperuricaemia

40

 

 

What drugs can cause seizures?

 

  • Overdoses
  • Illicit drugs of abuse
  • Alcohol withdrawal
  • Toxins

 

 

41

 

 

What are respiratory complications of status epilepticus?

 

  • Hypoxia
  • Aspiration pneumonitis
  • Respiratory acidosis

42

 

 

What are cardiovascular complications of status epilepticus?

 

  • Arrhythmias/Tachycardia
  • Hypo/hypertension

43

 

 

What are neurological complications of status epilepticus?

 

  • Primary brain injury - excitotoxic neuronal brain injury
  • Secondary brain injury - hypotension, hypoperfusion, hypoxia

44

 

 

What should you give immediately as someone starts seizing?

 

 

15L/min O2 therapy - non-rebreath mask

45

 

 

Why might you take a VBG in someone with acute seizure?

 

 

Assess lactate levels and acidosis

46

 

 

Why might you look at U+E's and Ca2+ in someone with acute seizure?

 

 

Look for electrolyte abnormalities

47

 

 

Why might you do an ECG in someone with acute seizure?

 

 

Look for features of prolonged QT interval