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 709: Clown Therapy

Podcast 709: Clown Therapy

Contributor: Jared Scott, MD Educational Pearls: Using LET, procedural sedation, and distraction techniques are often needed to successfully perform painful procedures in pediatrics patients The tech...

30 Elo 20214min

Podcast 708: Diagnostic Paracentesis

Podcast 708: Diagnostic Paracentesis

Contributor: Peter Bakes, MD Educational Pearls: Paracentesis is a procedure where fluid is removed from the peritoneal cavity by needle Indications for paracentesis include: large volume paracentesi...

24 Elo 20215min

Podcast 707: Sigmoid Volvulus

Podcast 707: Sigmoid Volvulus

Contributor: Aaron Lessen, MD Educational Pearls: Sigmoid volvulus occurs when the sigmoid colon twists 180 to 360 degrees 10% of intestinal obstructions in the US; 50-70% of intestinal obstructions ...

23 Elo 20213min

Podcast 706: Pepper Spray Decon

Podcast 706: Pepper Spray Decon

Contributor: Ramnik Dhaliwal, MD JD Educational Pearls: Pepper spray is a highly irritating compound with active ingredient of capsaicin Techniques to help decontaminate and alleviate symptoms of an ...

18 Elo 20213min

Podcast 705: Pyloric Stenosis

Podcast 705: Pyloric Stenosis

Contributor: Neil Cella, MD Educational Pearls: Pylorus becomes hypertrophied and does not allow food or liquid to pass through to the duodenum tOccurs between the ages of 3 weeks to 3 months Classic...

17 Elo 20214min

Podcast 704: Treatment of Pneumothorax

Podcast 704: Treatment of Pneumothorax

Contributor: Adam Barkin, MD Educational Pearls: Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exc...

16 Elo 20215min

Mental Health Monthly #8: Trauma-Informed Care

Mental Health Monthly #8: Trauma-Informed Care

Contributor: Randi Libbon, MD The Core features of trauma-informed care include: Patient empowerment, choice and collaboration. This means educating patients and allowing patients to make choices abo...

11 Elo 20219min

Podcast 703: Fever in Infants

Podcast 703: Fever in Infants

Contributor: Neil Cella, MD  Educational Pearls: 10% of patients 100.4) have an serious bacterial infection Most of these are UTIs, but also consider pneumonia and meningitis Requires CXR, LP, lab...

10 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