▪️Imp: Seizure
▪️Cond: emergency
▪️Diet: NPO(temporary)
▪️Act: CBR
▪️Position: left lateral decubitus
🔹At 0-5 minutes
▪️Protect patient from injury
*If possible, place patient in left lateral position to reduce risk of aspiration
*Do not place bite block!
*Jaw thrust, a NPA and oxygen may be required
▪️C.V.S
▪️IV line fix(at least 2 lines)
▪️IV fuids (usually crystalloids in boluses of 500 to 1000 mL) as necessary
* Patients with suspected shock.
* add vasopressors if IV fluids fail to restore adequate tissue perfusion.
▪️CM and POM
▪️provide 100% oxygen with mask
* Rapid sequence intubation should be performed if airway, ventilation, or oxygenation cannot be maintained, or if the seizure becomes prolonged
▪️check Serum glucose and a rapid "finger-stick" or point-of-care glucose.
▪️check Serum electrolytes, Calcium, phosphorus, and magnesium, Liver function tests, Complete blood count, Serum antiseizure medication levels( if applicable), Urine and blood toxicology, Qualitative pregnancy test (urine or blood) in women of childbearing age.
▫️ some studies suggest checking Serum lactate, as increasing levels may suggest hypoperfusion or underlying infection.
▪️100mg thiamine and 50ml of D50W IV infusion if indicated.(in hypoglycemic(BS<60s)
* Amp glucagon IM if IV access isn’t available
🔹Sizure continues after 5 minutes (status epilepticus)
▪️give first dose of benzodiazoine and an antiseizure medication(ASM)
* لاین داروهای بنزودیازپین از داروهای ضد تشنج باید جدا باشد.
▪️if IV access available
▫️Amp lorazepam 0.1mg/kg IV (alternative 4mg fixed dose) and max rate 2mg/min OR
▫️Amp diazepam 0.15mg/kg IV (max: 10mg per dose) and max rate 5mg/min
▪️ if IV access not achieved in 3 minutes:
▫️Amp midazolam IM 10mg or 0.2mg/kg( for>40kg)
OR
▫️Rectal diazepam gel 0.2 mg/kg (max:20mg)
▪️Amp levetiracetam 60mg/kg IV(max:4500mg) over 5-15 minutes
OR
▫️Amp valproate 40mg/kg IV (max: 3000mg) at 10mg/kg/min
or
▫️Amp phenytoin (20 mg/kg IV; do not exceed 1 mg/kg per minute; maximum rate: 50 mg per minute) diluted in N. S.
e.g Amp Phenytoin 20mg/kg at 300 cc N/S in 30 minutes
*Both fosphenytoin and phenytoin require cardiac and BP monitoring.
* فنی تویین باید از یه لاین جدا از بنزودیازپین تزریق گردد و همچنین نباید در سرم قندی انفوزیون شود
🔹Sizure continues after 5-10 minutes
▪️Give second dose of benzodiazepine(eg. lorazepam or diazepam)
🔹Sizure continues after 10-15 minutes
▪️Emergency consultation with neurologist
▪️EEG portable if available
*if diagnose of SE is uncertain
🔹Sizure continues after 15-30 minutes
▪️Give an ASM not previously used.
▪️ICU admission with continuous EEG
▪️prepare for potential intubation
🔹Sizure continues beyond 30 minutes
▪️Continuous IV infusion Midazolam(preferred), propofol or pentobarbital.
▫️Amp midazolame IV load with 0.2 mg/kg then infusion 0.05-2 mg/kg/h or
▫️Propofol IV 1 to 2 mg/kg loading dose then 1-10 mg/kg/h
▪️Use vasopressor as necessary
▪️ Maintain therapeutic dose of ASM level
🔹in which step that seizure stopped:
▪️︎close CM and POM until full recovered
▪️︎Perform complete neurological assessment
▪️︎Continuous EEg and neuroimaging to assess for NCSE
*if return to responsiveness is delayed by more than 1-2 hours
🔹Additional evaluation may include:
▫️ECG
▫️Neuroimaging(MRI or CT):
- if CSE is the first presentation of epilepsy
- there are new focal neurologic findings,
- signs of head trauma,
- suspicion for infection,
- concern for increased ICP,
- prolonged duration of depressed consciousness (ie, for >1 to 2 hours after the episode).
▫️If there is concern for infection, blood cultures should be obtained and empiric antimicrobials should be started prior to brain imaging, and LP should be performed after a space-occupying brain lesion has been excluded by imaging.
▫️LP
*if the clinical presentation is suggestive of an acute infection that involves the central nervous system, or if the patient has a history of a malignancy and there is concern for leptomeningeal metastases.
پایان.❤️
📝 فهرست مطالب کانال
#Episode_17