Status Epilepticus Flashcards
(38 cards)
Continuous seizure activity is seizure for ___ minutes
5
Risk of longterm consequences with seizure activity for > ___ minutes
30
__ is characterized by fluctuating state (epileptic twilight) that produces altered consciousness and/or behavior
non-convulsive status epilepticus (NCSE)
Continuous seizures for at least 5 mins or 2 seizures without return to consciousness in between
a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE
d. impending GCSE
stage 1 (0-30mins)
Continuous seizures for at least 30 mins or 30 mins of intermittent seizures without return to consciousness in between
a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE
a. established GCSE
stage 2 (30-60mins)
Continuous seizures despite initial treatment with 2-3 antiepileptic drugs
a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE
b. refractory GCSE
stage 3 (> 120mins)
Seizures that continue 24hrs or longer after the administration of anesthesia, including cases in which SE recurs on reduction or withdrawal of anesthesia
a. established GCSE
b. refractory GCSE
c. super-refractory GCSE
d. impending GCSE
c. super-refractory GCSE
stage 4 (> 24hrs)
Which type of status epilepticus has no structural lesion?
a. type I
b. type II
a. type I
Which type of status epilepticus has structural lesion?
a. type I
b. type II
b. type II
What is the most common excitatory neurotransmitter?
glutamate
most common cause of seizures
Excitatory neurotransmitters:
- glutamate
- calcium
- sodium
- substance P
- neurokinin B
What is the most important inhibitory neurotransmitter?
GABA
Inhibitory transmitters:
- GABA
- adenosine
- potassium
- neuropeptide Y
- opioid peptides
- galanin
What is first line for established GSCE?
phenytoin (IV) or fosphenytoin
Second line:
phenobarbital
valproate
Third line:
lacosamide
levetiracetam
What is first line for impending GSCE (0-30mins)?
IV lorazepam
may repeat in 5 mins if no response
consider IN or IM midazolam
what is first line for refractory GSCE (> 120mins)
midazolam, propofol, or pentobarbital infusions
if on propofol use continuous ECG monitoring
For refractory and super-refractory GSCE make sure cerebral perfusion pressure is > __mmHg and MAP is > 120mmHg
70, 120
For impending seizure prehospital care establishing IV/IO access is the first action to be taken
a. true
b. false
b. false
time should NOTS be wasted obtaining IV/IO access
first line in the hospital
Established GSCE:
Phenytoin should be given __
a. IM
b. IV
c. both
b. IV
fosphenytoin may be given IV or IM
Established GSCD:
Phenytoin dose/rate?
15-20mg/kg IVPB
rate < 50kg/min
mixed in propylene glycol diluent that can cause hypotension and cardiac arrhythmias
Established GSCE:
fosphenytoin dose/rate?
15-20mg PE/kg IVPB
rate < 150mg PE/min
Corrected phenytoin formula:
corrected phenytoin =
phenytoin level/adjustment x albumin + 0.1
Established GSCE:
total phenytoin or corrected phenytoin goal levels?
10-20mcg/mL
1-2 mcg/mL
Phenytoin is highly protein bound.
a. true
b. false
a. true
check free level if available
if not use total level and albumin and use corrected formula
The phenytoin adjustment factor is ___ in most pts, but ___ in pts with renal failure (CrCl < 20)
0.2, 0.1
Goal total phenytoin levels or corrected phenytoin levels for status epilepticus is __ to __ mcg/mL
10, 20
free phenytoin levels of 1-2mcg/mL
