Status Epilepticus (Midterm)

Front 1

Definition of status epilepticus? (2 possibilities)

Back 1

Continuous seizure activity of greater than 10 minutes, or more than 2 seizures without full recovery of consciousness between seizures.

Front 2

Diagnostic testing options (4)

Back 2

1. Lab studies

2. LP

3. EEG

4. Neuroimaging (noncontrast CT)

Front 3

Most common cause in adults?

...Children?

...common for both?

Back 3

Adults: cerebrovascular disease

Children: fever/infection

Other: Medication

Front 4

Treatment algorithm:

Step 1? (3 things)

Back 4

Assess ABCs

Check glucose (if <80, give D50, if alcoholic/malnourished, give 100mg thiamine with glucose)

Monitor VS and pulse ox

Front 5

Algorithm: Step 2 (2, possibly 3 drugs)

Back 5

Lorazepam (.1mg/kg at 2mg/min)
and
Fosphenytoin (20mg/kg at 150mg/min)

(consider valproic acid 20 mg/kg at 5mg/kg/min
- use when: hypotension, when there is a known hypersensitivity to phenytoin or when status is resulting from noncompliance in patients on valproic acid)

Front 6

Algorithm: Step 3 (4) steps

Back 6

If seizure continues, patient is now in Refractory Status Epilepticus
- Consult Neurology
- Arrange for EEG monitoring
- Strongly consider intubation
- Select drugs for Refractory SE

Front 7

Drugs for refractory SE? (3 options + doses)

Back 7

Midazolam 0.2 mg/kg bolus  0.05-2 mg/kg/hr
or
Pentobarbital 5-15 mg/kg slow push  0.5-10 mg/kg/hr
or
Propofol 3-5 mg/kg bolus  1-15 mg/kg/hr

Front 8

What to do if you intubate patient or if subtle SE suspected?

Back 8

Place EEG monitors!!!