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

Episoder(1145)

Podcast 883: Migraine Treatment in Cardiovascular Disease

Podcast 883: Migraine Treatment in Cardiovascular Disease

Contributor: Jorge Chalit, OMS II Educational Pearls: Migraine pathophysiology Primarily mediated through the trigeminovascular system Serotonin, dopamine, and calcitonin gene-related peptide (...

25 Des 20233min

Podcast 882: Thrombolytics for Minor Strokes

Podcast 882: Thrombolytics for Minor Strokes

Contributor: Aaron Lessen MD Educational Pearls: How is the severity of a stroke assessed? Strokes are assessed by the NIH Stroke Scale (NIHSS), this scale has different tasks, such as asking the pe...

20 Des 20232min

Podcast 881: Pediatric Readmissions

Podcast 881: Pediatric Readmissions

Contributor: Nick Tsipis MD Educational Pearls: The review article assessed 16.3 million patients across six states to identify those at high-risk for critical revisit Criteria for critical revis...

12 Des 20233min

Podcast 880: OB Delivery in the ED

Podcast 880: OB Delivery in the ED

Contributor: Meghan Hurley MD Educational Pearls: Pearls about labor: Labor is split into 3 stages. Stage 1 starts when the first persistent contractions are felt and goes up until the cervix is ...

4 Des 20238min

Podcast 879: A Case of Pediatric Anaphylactic Shock

Podcast 879: A Case of Pediatric Anaphylactic Shock

Contributor: Dr. Taylor Lynch Educational Pearls: Time of arrival until intubation was 26 minutes but nobody tried anterior neck access like a cricothyrotomy until his dad arrived Traditional ACLS...

27 Nov 20235min

Podcast 878: Opioids for Low Back and Neck Pain

Podcast 878: Opioids for Low Back and Neck Pain

Contributor: Jared Scott MD Educational Pearls: Should we use opioids to treat low back and neck pain? The OPAL Trial, published in The Lancet, in June 2023, attempted to answer this very question. ...

20 Nov 20233min

Podcast 877: Viral Respiratory Infections in Children

Podcast 877: Viral Respiratory Infections in Children

Contributor: Jared Scott MD Educational Pearls A recently published study assessed the burden of respiratory viruses in a longitudinal cohort of children from 0 to 2 years of age The children in t...

13 Nov 20233min

Podcast 876: Sedation Pearls

Podcast 876: Sedation Pearls

Contributor: Travis Barlock MD Educational Pearls: Common sedatives used in the Emergency Department and a few pearls for each. Propofol Type: Non-barbiturate sedative hypnotic agonizing GABA rec...

6 Nov 20235min

Populært innen Vitenskap

fastlegen
tingenes-tilstand
rekommandert
jss
vett-og-vitenskap-med-gaute-einevoll
rss-nysgjerrige-norge
rss-rekommandert
sinnsyn
smart-forklart
nordnorsk-historie
villmarksliv
rss-paradigmepodden
forskningno
pod-britannia
fjellsportpodden
aldring-og-helse-podden
diagnose
rss-overskuddsliv
tomprat-med-gunnar-tjomlid
tidlose-historier