Template:Seizure actively seizing management: Difference between revisions

(Changed order of meds per 2016 guidelines)
No edit summary
Line 1: Line 1:
#Protect patient from injury
*Protect patient from injury
#*If possible place patient in left lateral position to reduce risk of aspiration
**If possible, place patient in left lateral position to reduce risk of aspiration
#*Do not place bite block
**Do not place bite block!
#*Ensure clear airway after seizure stops
*[[Benzodiazepine]]
#[[Benzodiazepine]]
**Initial therapy of choice<ref>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.</ref>
#*Initial therapy of choice<ref>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.</ref>
**[[Midazolam]] IM 10mg (>40kg), 5mg (13-40kg), or 0.2mg/kg<ref>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</ref> - may also be given IN
#**[[Midazolam]] IM 10mg (>40kg), 5mg (13-40kg), or 0.2mg/kg<ref>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</ref>
**[[Lorazepam]] IV 2mg or 0.1mg/kg
#**[[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)
#**[[Diazepam]] IV 0.15-0.2mg/kg (up to 10mg)
*Secondary medications
#*Alternatives
**[[Fosphenytoin]] IV 20-30mg/kg at 150mg/min (may also be given IM)
#**[[Diazepam]] PR 0.2-0.5mg/kg (up to 20mg)
***Contraindicated in pts w/ 2nd or 3rd degree AV block
#**[[Midazolam]] PN or Buccal
**[[Valproic acid]] IV 20-40mg/kg at 5mg/kg/min  
#Secondary medications
**[[Levetiracetam]] IV 60mg/kg, max 4500mg/dose
#*[[Fosphenytoin]] 20-30mg/kg/PE at 150mg/min
**[[Phenobarbital]] IV 20mg/kg at 50-75mg/min (be prepared to intubate)
#**Contraindicated in pts w/ 2nd or 3rd degree AV block
*Refractory medications
#**May be given IM
**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''
#*[[Valproic acid]] IV 20-40mg/kg at 5mg/kg/min  
**[[Midazolam]] 0.2mg/kg, then infusion of 0.05-2mg/kg/hr '''OR'''
#*[[Levetiracetam]] IV 60mg/kg, max 4500mg/dose
**[[Ketamine]] 1.5mg/kg, then infusion of 0.01-0.05mg/kg/hr
#*[[Phenobarbital]] IV 20mg/kg at 50-75mg/min (be prepared to intubate)
**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>
#Refractory medications
*Consider
#*[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr OR
**Secondary causes of seizure (e.g. [[hyponatremia]], hypoglycemia, [[INH toxicity]], [[ecclampsia]])
#*[[Midazolam]] 0.2mg/kg then inusion of 0.05-2mg/kg/hr OR
**Nonconvulsive seizures or status epilepticus - get EEG
#*[[Ketamine]] 1.5mg/kg then 0.01-0.05mg/kg/hr
#*Anesthesia consult for inhaled anesthetics in OR for refractory status epilepticus<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
#*Secondary causes of seizure (e.g. [[hyponatremia]], hypoglycemia, [[INH Toxicity, [[ecclampsia]])
#*EEG to rule-out nonconvulsive status
#*Prophylactic intubation

Revision as of 09:26, 3 April 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 therapy 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 1.5mg/kg, then infusion of 0.01-0.05mg/kg/hr
    • Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)[3]
  • 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. ↑ Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.
Retrieved from "https://www.wikem.org/w/index.php?title=Template:Seizure_actively_seizing_management&oldid=62087"