Template:Seizure actively seizing management: Difference between revisions

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**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''
**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''
**[[Midazolam]] 0.2mg/kg, then infusion of 0.05-2mg/kg/hr '''OR'''
**[[Midazolam]] 0.2mg/kg, then infusion of 0.05-2mg/kg/hr '''OR'''
**[[Ketamine]] 1.5mg/kg, then infusion of 0.01-0.05mg/kg/hr
**[[Ketamine]] loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr<ref>Legriel S, Oddo M, and Brophy GM. What’s new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.</ref>
**Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)<ref>Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.</ref>
**Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)<ref>Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.</ref>
*Consider
*Consider
**Secondary causes of seizure (e.g. [[hyponatremia]], hypoglycemia, [[INH toxicity]], [[ecclampsia]])
**Secondary causes of seizure (e.g. [[hyponatremia]], hypoglycemia, [[INH toxicity]], [[ecclampsia]])
**Nonconvulsive seizures or status epilepticus - get EEG
**Nonconvulsive seizures or status epilepticus - get EEG

Revision as of 16:18, 31 August 2016

  • Protect patient from injury
    • If possible, place patient in left lateral position to reduce risk of aspiration
    • Do not place bite block!
  • Benzodiazepine (Initial treatment of choice)[1]
    • Midazolam IM 10mg (>40kg), 5mg (13-40kg), or 0.2mg/kg[2] - may also be given IN
    • Lorazepam IV 2mg or 0.1mg/kg
    • Diazepam IV 0.15-0.2mg/kg (up to 10mg) or PR 0.2-0.5mg/kg (up to 20mg)
  • Secondary medications
    • Fosphenytoin IV 20-30mg/kg at 150mg/min (may also be given IM)
      • Contraindicated in pts w/ 2nd or 3rd degree AV block
    • Valproic acid IV 20-40mg/kg at 5mg/kg/min
    • Levetiracetam IV 60mg/kg, max 4500mg/dose
    • Phenobarbital IV 20mg/kg at 50-75mg/min (be prepared to intubate)
  • Refractory medications
    • Propofol 2-5mg/kg, then infusion of 2-10mg/kg/hr OR
    • Midazolam 0.2mg/kg, then infusion of 0.05-2mg/kg/hr OR
    • Ketamine loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr[3]
    • Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)[4]
  • Consider
  1. ↑ Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.
  2. ↑ McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582
  3. ↑ Legriel S, Oddo M, and Brophy GM. What’s new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.
  4. ↑ Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.
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