Podcast 576: Status Epilepticus Drugs

Podcast 576: Status Epilepticus Drugs

Author: Charlene Gnisci Melton, PharmD

Educational Pearls:

  • Status Epilepticus is defined as continuous seizure activity for >5 minutes, or 2 or more seizures without full return to consciousness between events
  • Status epilepticus is a true neurologic emergency with significant morbidity and mortality
  • Aggressive, early treatment of status epilepticus is essential as GABA receptors will regress over time and make benzodiazepines less effective as time elapses
  • Go large with doses of benzodiazepines and repeat doses if necessary: In adults this means lorazepam 4 mg IV push or Midazolam 10 mg intramuscular if no IV access
  • Second line agents include:
    • Levetiracetam (Keppra) 60 mg/kg up to 4500mg
    • Valproic Acid (40 mg/kg up to 3000 mg)
    • Keppra has an arguably better side effect profile and compatibility compared to other second-line agents
  • Third line agents include intubation and sedation with propofol, benzodiazepines, or even ketamine

Editor's note: from a time management perspective, call for your second-line treatment early to get it from pharmacy while you slam the benzodiazepines, then it will be arriving hopefully when you need it, and no harm if you don't. Oh, and don't forget a fingerstick glucose.

References

Glauser T, Shinnar S, Gloss D, 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. doi:10.5698/1535-7597-16.1.48

Walker, M.C. Pathophysiology of status epilepticus. Neuroscience Letters. 2018:667:84-91. https://doi.org/10.1016/j.neulet.2016.12.044

Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD

Jaksot(1145)

Podcast 716: Resuscitation Fluids

Podcast 716: Resuscitation Fluids

Contributor: Nick Tsipis, MD Educational Pearls: Fluid choice may have an impact on outcomes in resuscitation, and a meta-analysis has relevant insight into their use in sepsis and trauma patients La...

29 Syys 20214min

Podcast 715: Heated High Flow O2

Podcast 715: Heated High Flow O2

Contributor: Nick Hatch, MD Educational Pearls: High flow nasal cannula (HFNC) or "heated high flow" can deliver higher oxygen levels than nasal cannula It typically is used as an "intermediate" betw...

27 Syys 20214min

Podcast 714: Intradermal Sterile Water for Back Pain

Podcast 714: Intradermal Sterile Water for Back Pain

Contributor: Aaron Lessen, MD Educational Pearls: Randomized controlled-trial evaluated intradermal injections of sterile water to manage low back pain versus an IV NSAID Four intradermal injections ...

21 Syys 20213min

Podcast 713: Oral Ketamine

Podcast 713: Oral Ketamine

Contributor: Don Stader, MD Educational Pearls: Those on chronic opioid therapy may have high tolerance to opioids and/or opioid hyperalgesia Ketamine is a good adjunct for pain control in patients o...

20 Syys 20213min

Podcast 712: Cephalosporin with a Penicillin Allergy

Podcast 712: Cephalosporin with a Penicillin Allergy

Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study in the Kaiser system looked at over 4 million patients receiving antibiotics to determine the effect of penicillin allergy...

13 Syys 20213min

On the Streets #10: IO Administration Gone Awry

On the Streets #10: IO Administration Gone Awry

Dr. Glenda Quan, trauma surgeon from Swedish Medical Center joins our host Jordan Ourada to review a case of an incorrectly placed IO and how to avoid it. The Emergency Medical Minute is excited to an...

8 Syys 202115min

Podcast 711: Insulin Pumps

Podcast 711: Insulin Pumps

Contributor: Aaron Lessen, MD Educational Pearls: Insulin pumps provide a continuous infusion of fast-acting insulin using a basal rate and bolus prior to meals Some connect to a continuous glucomete...

7 Syys 20214min

Podcast 710: Droperidol vs. Zyprexa

Podcast 710: Droperidol vs. Zyprexa

Contributor: Nick Tsipis, MD Educational Pearls: Prospective trial studied 5 mg IM droperidol to 10 mg IM olanzapine (Zyprexa) in the reducing levels of agitation Time to adequate sedation was about ...

31 Elo 20215min

Suosittua kategoriassa Tiede

tiedekulma-podcast
rss-mita-tulisi-tietaa
rss-poliisin-mieli
rss-duodecim-lehti
docemilia
filocast-filosofian-perusteet
rss-ammamafia
rss-luontopodi-samuel-glassar-tutkii-luonnon-ihmeita
rss-sosiopodi
utelias-mieli
radio-antro
rss-astetta-parempi-elama-podcast
rss-tiedetta-vai-tarinaa