Status epilepticus

Question 1

Which A-E does this affect?

Answer 1

A

Question 2

Airway

Answer 2

1. START THE CLOCK

Look: hypersalivation, tongue biting
Listen: gargling

Suction secretions, put airway adjuncts

Call anaesthetics STAT to secure airwway as airway is at risk - 2222

Question 3

Breathing

Answer 3

Look: respiratory distress, cyanosis
Listen: lung sounds
Feel: tracheal deviation, chest expansion

O2, RR

GIVE O2

ABG: ?lactate, glucose!
?Xray POST seizure (for risk of aspiration)

Question 4

Circulation

Answer 4

Look: mottled, diaphoresis
Listen: heart sounds normal
Feel: CRT (might be reduced), pulses

BP, HR

Get IV access!! 2 wide bore cannulae (14,16) in the 2 antecubital fossae

Investigations:
1. FBC (WCC rule out sepsis), UEs, LFTs, CRP, ESR, TOXICOLOGY blood cultures (rule out septicaemia)
2. consider CT/head
3. consider LP

Management:
STEP 1
- 10 mg Buccal lorazepam/ Rectal diazepam OR 4 mg IV lorazepam
- repeat dose after 10 minutes

NOTE: if alcoholism suspected: thiamine 250mg IV over 30 minutes

if hypoglycaemia 100ml 20% glucose

STEP 2
- IV phenytoin infusion 18mg/kg
- Do not use if bradycardic or heart block
- Requires ECG and BP monitoring

STEP 3
ICU requirement
- Intubate and ventilate
- continuous EEG monitoring

Dexamethasone 10 mg IV if vasculitis or cerebral oedema suspected

Treat the cause: hypoglycaemia, pregnancy, alcohol, drugs, CNS lesions, inadequate anticonvulsant dose)

Question 5

Disablity

Answer 5

PEARL
Focal neurology (rule out SOL, CNS infection)
GCS score
BM! - correct if low
Look at drug chart
EEG

Question 6

Exposure

Answer 6

• any infected sites PICC lines or drains - sepsis
• rashes (non blanching)
• calves
• temperature
• incontinence
• urine tox screen

Question 7

Management of Status epilepticus

Answer 7