Status Epilepticus (Medical Students)
Status epilepticus is defined as recurrent or continuous seizure activity lasting longer than 30 minutes in which the patient does not regain baseline mental status. Prolonged seizures are associated with cerebral hypoxia, hypoglycemia, and hypercarbia and with concurrent and progressive lactic and respiratory acidosis. Neuronal destruction can occur and may be irreversible,
Management
- Secure airway and suction
- High-flow 100% O2 by mask.
Pulse oximetry.
- Establish IV access (if unsuccessful,
give rectal diazepam)
- Check capillary blood glucose (and
treat hypoglycemia)
- Drugs (Diazepam PO/PR at t=0; may
repeat at 5 min; Phenytoin infusion at 10 min)
- Recovery position
T=0 min
|
Diazepam (Valium, Diazemuls)
0.3 mg/kg IV
over 1 min
or 0.4 mg/kg
PR
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May cause
apnoea and hypotension.
|
T=5 min
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Diazepam (Valium, Diazemuls)
0.3 mg/kg IV
over 1 min
or 0.4 mg/kg
PR
|
As above
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T=10 min
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Phenytoin (Epanutin)
18 mg/kg
(max 1g) IVI over 30-45 min
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Dilute in N
Saline (max concentration 10mg/ml). Infusion rate not greater than
1mg/kg/min. Monitor ECG and BP
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