Template:Seizure actively seizing management: Difference between revisions

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(Changed order of meds per 2016 guidelines)
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#*Ensure clear airway after seizure stops
#*Ensure clear airway after seizure stops
#[[Benzodiazepine]]
#[[Benzodiazepine]]
#*[[Lorazepam]] 2mg IV (first line)<ref>Treiman D, Meyers P, Walton N, et al. A comparison of four treatments for generalized convulsive status epilepticus. New Engl J Med 1998; 339; 792-798</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>
#*IM Options:
#**[[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>
#**[[Midazolam]] IM 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> OR
#**[[Lorazepam]] IV 2mg or 0.1mg/kg
#**[[Diazepam]] PR 0.5-1.0mg/kg (up to 20mg)
#**[[Diazepam]] IV 0.15-0.2mg/kg (up to 10mg)
#*Alternatives
#**[[Diazepam]] PR 0.2-0.5mg/kg (up to 20mg)
#**[[Midazolam]] PN or Buccal
#Secondary medications
#Secondary medications
#*[[Lorazepam]] 2mg IV (up to 0.1mg/kg) OR [[diazepam]] 5-10mg IV (up to 0.15mg/kg); AND
#*[[Fosphenytoin]] 20-30mg/kg/PE at 150mg/min
#*[[Phenytoin]] 20-30mg/kg at 50mg/min OR [[fosphenytoin]] 20-30mg/kg/PE at 150mg/min
#**Contraindicated in pts w/ 2nd or 3rd degree AV block
#**[[Phenytoin]]/[[fosphenytoin]] contraindicated in pts w/ 2nd or 3rd degree AV block
#**May be given IM
#**[[Phenytoin]] may cause hypotension due to propylene glycol diluent
#*[[Valproic acid]] IV 20-40mg/kg at 5mg/kg/min
#**[[Fosphenytoin]] may be given IM
#*[[Levetiracetam]] IV 60mg/kg, max 4500mg/dose
#*[[Phenobarbital]] IV 20mg/kg at 50-75mg/min (be prepared to intubate)
#Refractory medications
#Refractory medications
#*[[Valproic acid]] 20-40mg/kg at 5mg/kg/min OR
#*[[Phenobarbital]] 20mg/kg at 50-75mg/min (be prepared to intubate) OR
#*[[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 inusion of 0.05-2mg/kg/hr OR
#*[[Midazolam]] 0.2mg/kg then inusion of 0.05-2mg/kg/hr OR
#*[[Ketamine]] 1.5mg/kg then 0.01-0.05mg/kg/hr
#*[[Ketamine]] 1.5mg/kg then 0.01-0.05mg/kg/hr
#**Contraindicated in pts w/ intracranial masses
#*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
#Consider
#*Secondary causes of seizure (e.g. [[hyponatremia]], hypoglycemia, [[INH Toxicity, [[ecclampsia]])
#*Secondary causes of seizure (e.g. [[hyponatremia]], hypoglycemia, [[INH Toxicity, [[ecclampsia]])
#*EEG to rule-out nonconvulsive status
#*EEG to rule-out nonconvulsive status
#*Prophylactic intubation
#*Prophylactic intubation
#*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>

Revision as of 15:13, 9 March 2016

  1. Protect patient from injury
    • If possible place patient in left lateral position to reduce risk of aspiration
    • Do not place bite block
    • Ensure clear airway after seizure stops
  2. Benzodiazepine
  3. Secondary medications
    • Fosphenytoin 20-30mg/kg/PE at 150mg/min
      • Contraindicated in pts w/ 2nd or 3rd degree AV block
      • May be given IM
    • 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)
  4. Refractory medications
    • Propofol 2-5mg/kg, then infusion of 2-10mg/kg/hr OR
    • Midazolam 0.2mg/kg then inusion of 0.05-2mg/kg/hr OR
    • Ketamine 1.5mg/kg then 0.01-0.05mg/kg/hr
    • Anesthesia consult for inhaled anesthetics in OR for refractory status epilepticus[3]
  5. Consider
    • Secondary causes of seizure (e.g. hyponatremia, hypoglycemia, [[INH Toxicity, ecclampsia)
    • EEG to rule-out nonconvulsive status
    • Prophylactic intubation
  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.
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