status epilepticus Flashcards
(21 cards)
what is the definition of status epilepticus
5 minutes or more of continuous seizure, or recurrent seizure activity without recovery between seizures
what are convulsions associated with rhythmic jerking of extremities, often with mental status impairment
generalized convulsive status epilepticus (GCSE)
what is the categorization of seizures that are seen on EEG without convulsions
non-convulsive status epilepticus
what are the 4 etiological chronic SE factors
- preexisting epilepsy
- CNS tumors
- Chronic alcohol abuse
- remote CNS pathology
what is the clinical presentation of SE
- altered consciousness
- hyperthermia
- hypertension
- metabolic acidosis
- hypoxia/ resp. failure
what are the treatment goals of SE.
- cessation of clinical and electrographic seizure activity
- maintain ABCs (airway, breathing, circulation)
- determine/ treat underlying causes
- prevent recurrent seizures
what IV fluids are commonly given to pts. with SE
100 mg thiamine + 50 mL 50% dextrose
what 3 benzo’s and their route are often given for treating SE
- lorazepam IV
- midazolam IM
- diazepam PR
what is used for urgent control therapy of SE
- fosphenytoin/ phenytoin
- valproic acid derivatives
- midazolam
- phenobarbital
- levetiracitam
what is the first line for IM administered SE treatment
midazolam (No IV access)
why can phenytoin cause hypotension and arrhythmias
contains propylene glycol
what is the loading dose of phenytoin for SE
20 mg/kg IV
what is the max infusion rate of phenytoin for SE
50 mg/ min
what fluids is phenytoin compatible in?
only compatible in 0.9% normal saline
what is the loading dose of fosphenytoin for SE
20 mg/kg IV (same as phenytoin)
what is the max infusion rate of fosphenytoin for SE
150 mg/ min
why is fosphenytoin preferred over phenytoin
- less infusion site reactions
- fewer hemodynamic effects
- faster rate of infusion (150 mg/min)
what is continued clinical or electrographic seizures after adequate doses of BDZ and another antiepileptic
refractory SE
what is most often recommended for refractory SE
- midazolam IV
- propofol infusion
- pentobarbital infusion
what is also mandarory in addition to pharm treatment for refractory SE
mechanical ventilation and EEG
what factors are associated with poor mortality outcomes with SE
- underlying etiology
- older age
- impaired consciousness
- duration of seizures
- medical complications and/ or comorbidities
