Template:Seizure actively seizing management: Difference between revisions
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#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 | ||
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#[[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> | #*[[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> | ||
#* | #*IM Options: | ||
#**[[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 | #**[[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 | ||
#**[[Diazepam]] PR 0.5-1.0mg/kg (up to 20mg) | #**[[Diazepam]] PR 0.5-1.0mg/kg (up to 20mg) | ||
#Secondary medications | |||
#*[[Lorazepam]] 2mg IV (up to 0.1mg/kg) OR [[diazepam]] 5-10mg IV (up to 0.15mg/kg); AND | |||
#*[[Phenytoin]] 20-30mg/kg at 50mg/min OR [[fosphenytoin]] 20-30mg/kg/PE at 150mg/min | |||
#**[[Phenytoin]]/[[fosphenytoin]] contraindicated in pts w/ 2nd or 3rd degree AV block | |||
#**[[Phenytoin]] may cause hypotension due to propylene glycol diluent | |||
#**[[Fosphenytoin]] may be given IM | |||
#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 | |||
#*[[Midazolam]] 0.2mg/kg then inusion of 0.05-2mg/kg/hr OR | |||
#*[[Ketamine]] 1.5mg/kg then 0.01-0.05mg/kg/hr | |||
#**Contraindicated in pts w/ intracranial masses | |||
#Consider | |||
#*Secondary causes of seizure (e.g. [[hyponatremia]], hypoglycemia, INH overdose, [[ecclampsia]]) | |||
#*EEG to rule-out nonconvulsive status | |||
#*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 22:00, 19 December 2015
- 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
- Benzodiazepine
- Secondary medications
- Lorazepam 2mg IV (up to 0.1mg/kg) OR diazepam 5-10mg IV (up to 0.15mg/kg); AND
- Phenytoin 20-30mg/kg at 50mg/min OR fosphenytoin 20-30mg/kg/PE at 150mg/min
- Phenytoin/fosphenytoin contraindicated in pts w/ 2nd or 3rd degree AV block
- Phenytoin may cause hypotension due to propylene glycol diluent
- Fosphenytoin may be given IM
- 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
- Midazolam 0.2mg/kg then inusion of 0.05-2mg/kg/hr OR
- Ketamine 1.5mg/kg then 0.01-0.05mg/kg/hr
- Contraindicated in pts w/ intracranial masses
- Consider
- Secondary causes of seizure (e.g. hyponatremia, hypoglycemia, INH overdose, ecclampsia)
- EEG to rule-out nonconvulsive status
- Prophylactic intubation
- Anesthesia consult for inhaled anesthetics in OR for refractory status epilepticus[3]
- ↑ 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
- ↑ 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
- ↑ Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.