SE & Encephalitis

Question 1

Why would a patient with status epilepticus be in critical care?

Answer 1

For control of seizures
Or if injury occurred with seizure

Question 2

Definition of SE

Answer 2

• Seizure activity lasting longer than 5-10 min
• Normal brain function (LOC) does not return between seizures (lasts several hours
• Most common with tonic-clonic seizures

Question 3

Diagnostics for SE

Answer 3

Looking for any type of bloodwork or factor that could be causing the seizures:
Electrolytes
Liver enzymes
Toxic medication levels
ABGs
Cardiac enzymes
*CT or MRI
EEG

(If not cause found, pt diagnosed with epilepsy)

Question 4

Oxygenation/Airway management during a seizure

Answer 4

*Cannot put an airway in during a seizure
Use oxygen and suction as needed
To open airway if needed, use jaw thrust

Intubation between seizures
NG tube between seizures to prevent aspiration

Question 5

*Medications (in order of administration) for status epilepticus

Answer 5

1: IV NS
2: IV Ativan or IV Valium (in small increments)
3: IV phenytoin or fosphenytoin
4 IV propofol (if sedation required)

Question 6

How would you give a patient Ativan or Valium?

Answer 6

Start with smallest dose of whichever one is ordered
~Wait 1.5-2 min before giving more~
Give same drug at 1/2 of order amount

If this drug isn’t working, switch to 2nd drug and do same thing

Note whichever drug is successful at bringing pt out of seizure. This will be the drug that is used from then on

Question 7

How would a pt be given phenytoin or fosphenytoin?

Answer 7

1st: Bolus
Then: 4-6 hr piggyback

*Caustic to veins, need to push very slowly and be careful with IV sites

Question 8

Definition of encephalitis

Answer 8

Life threatening inflammation of the brain with viral etiology
Causes significant neuro deficits

Question 9

Possible etiologies of encephalitis

Answer 9

Arbovirus (mosquito or tick bite)
Non-epidemic (Herpes simplex type 1)
Enterovirus (most common):
- polio
- herpes zoster
- mumps
- chicken pox

Question 10

What would you ask a pt who you believe has encephalitis from an arbovirus?

Answer 10

Have you been outside of the country recently?

Question 11

Patho of encephalitis

Answer 11

• Infection from virus causes inflammation of brain tissue
• Destruction from degeneration and demyelination
• Death caused by increased ICP leading to herniation

Question 12

S/S of encephalitis

Answer 12

Fever
N/V
HA and neck pain
Mental status changes
Motor deficits
Neurological deficits
Fatigue
Seizures

Question 13

Treatment for encephalitis

Answer 13

Meds based on viral etiology
Most common: acyclovir (Zovirax) for herpes zoster

(Drug therapy not available for arbovirus and enterovirus)

Treat symptoms accordingly, like increased ICP and wait it out