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17 Cards in this Set
- Front
- Back
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Primary indications for ECT
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1. Depression
2.Mania 3. SZ 4. Acute suicidally with bight risk 5. Psychotic Dep/mania 6. Rapid deterioration of physical status due to psych complication (MDD/ psychosis) 7. Hx of poor response to meds. 8. Hx of good response to ECT 9. Patient preference 10. Medication outweight risk for ECT. 11. Catatonia |
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Secondary indications for ECT
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Catatonia
Parkinson disease NMS Mood d/o due to GMC Delirium Intractable status epileptic |
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Describe physiological changes during onset of ECT: electrical stimulation and tonic phase.
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decrease systolic and diastolic. Dec HR/ asystole.
Resp. Arrest |
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Describe the physiological changes during Mid ECT: clonic phase
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Elevated HR
Elevated BP within 10-20 " after stimulation. |
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Describe physiological changes during late ECT: post ictal phase
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Parasympathetic response. bradycardia/ asystole
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Meds useful during clonic phase
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Beta blockers
Ca Chanel blockers Nitroglycerine |
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Meds useful during post ictal phase
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Glycopyrrolate
Atropone |
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Whe succinylcholine is contraindicated
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Malignant hyperthermia
NMS Plasma cholinesterase deficiency Hyperkalemia |
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Relative contraindications
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Recent MI
Unstable angina Severe valvular heart disease Descompensated CHF aneurysm or Vascular malformation Increased intracraneal pressure. Recent cerebral infarction/ bleed Severe arrhythmia Increased ICP/ herniation pheochromocytoma Brain tumor Severe COPD/ asthma ASA level 4 or 5 |
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Mortality in ECT
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1: 80000 treatments
1: 10000 pts |
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If brain trauma
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Avoid overstimulation over skull defect.
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List 3 special considerations doing ECT in geriatric population
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1. Seizure threshold rises with age.
2. Icreased risk of ECT related cognitive effects. 3. increased medical comorbidity may increase the anesthetic risk. |
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How can you reduced risk of cognitive impairment
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Using BF or RUL instead of Bitemporal.
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Causes of aborted seizures in ECT
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1. excessive impedance from poor skin contact
2. inadequate ventilation 3. dehydrtion, 4.medications (BZD, anticonvulsants) insufficient stimulus |
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What to do if aborted /missed seizure
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1.correct possible causes
2. if missed: restimulate after 20 seconds at higher dose 3. if aborted: restimulate after 40 sec at a higher dose. 4. caffeine 1h pre-ect 5. flumazenil (if higher dose of BZD, but give midazolam in PAR to prevent withdrawal. |
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What decreases seizure threshold
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caffeine
neuroleptics (clozapine) hyperventilation sleep deprivatioon Burpropion |
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How do you know there is ECT adequacy?
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Clinical response
EEG morphology: high amplitud sharp post ictal supression simmetry between hemispheres(ictal coherence) regularity |
