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Status epilepticus (Aetiology (Metabolic
Electrolyte disturbance (high Na…
Status epilepticus
Aetiology
Metabolic
Electrolyte disturbance (high Na, low Ca)
Hypoglycamia
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Infection
Intercurrent illness e.g. influenza
Encephalitis, meningitis
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Vascular
CVD (stroke, TIA)
Drugs
AED withdrawal
Alcohol intoxication
Toxins (cocaine, CO, TCAs)
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Complications
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Cerebral
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Cerebral damage
(hypoxia, electrolytes, seizure)
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Diagnosis
Examination
Neuro
Colour, tone, unusual movements,
conciousness level
Resp
Cyanotic/mottled, irregular breathing, loss of airway
Investigations
Bedside
Obs (shock, fever)
ECG (arrhythmias)
Bloods
ABG (resp failure, lactate) FBC (infection), CRP (infection)
U+Es, Ca (electrolyte disturbance), Glucose (hypoglycaemia)
LFTs (liver failure), AED levels, Toxicology screen
Blood cultures (infection)
Imaging
CXR: pneumonia
CT head: intracranial pathology, hydrocephalus
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History
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PC/HPC
Pre-seizure: activity, trigger
Peri-seizure: LOC, movements, cyanosis,
loss of bowel/bladder control, tongue biting
Post-seizure: confusion, fatigue
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SH
Living arrangements, occupation/school,
diet, alcohol, smoking
Pathophysiology
Mechanism
Increased cerebral hypoxia, thus increased cerebral damage
Increased duration of seizure reduces cerebral perfusion
May become treatment resistant
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Management
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Definitive
Early treatment
(<10min)
Step 1
No IV access
Rectal diazepam,
buccal midazolam
IV access
IV/IO lorazepam 4mg (2mg/min), repeat at 10min
OR IV diazepam 10mg (2.5mg/min)
Step 2
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Not on phenytoin
IV phenytoin (20m infusion with ECG monitor;
serum levels at 2h and 24h)
Alternatives fosphenytoin, valproate, levatiracetam
Late treatment (>30min)
RSI (propofol, midazolam, thiopental)
Transfer to ITU
EEG monitoring
Once stable, use normal maintenance AEDs
Investigate cause (CT head, CSF analysis, etc.)
Definition
Continuous, generalised seizures
lasting >30min OR 2+ seizures
without intervening recovery
MEDICAL EMERGENCY
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