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 633: Pathologic Femur Fractures

Podcast 633: Pathologic Femur Fractures

Contributor: Jared Scott, MD Educational Pearls: Pathologic bone fractures occur due to weakened bones from chronic disease and with less force when compared to non-pathologic fractures Can be due to...

19 Jan 20215min

Podcast 632: Neonatal Jaundice

Podcast 632: Neonatal Jaundice

Contributor: Jared Scott, MD Educational Pearls: Bilirubin is natural breakdown product of red blood cells but can be neurotoxic if levels become too high Fetal red blood cells are fragile and break ...

18 Jan 20216min

Pharmacy Phriday #7: Bactrim Adverse Events

Pharmacy Phriday #7: Bactrim Adverse Events

Contributor: Cheyenne Bean, PharmD Educational Pearls: Bactrim (TMP-SMX) is a sulfa antibiotic used for a number of infections but can have untoward effects. Hypoglycemia can be induced by the sulfa ...

15 Jan 20214min

Podcast 631: UK COVID-19 Mutation

Podcast 631: UK COVID-19 Mutation

Contributor: Gretchen Hinson, MD Educational Pearls: Viruses mutate frequently and a new variant of COVID has been found in the United Kingdom. Mutations typically occur due to transcription errors d...

13 Jan 20215min

Podcast 630: Evolution of an STEMI

Podcast 630: Evolution of an STEMI

Contributor: Peter Bakes, MD Educational Pearls: Hyperacute T waves can occur immediately and typical last less than an hour Hyperacute T waves are typically broader than peaked T-waves, which are ...

12 Jan 20215min

Podcast 629: Inferior STEMI

Podcast 629: Inferior STEMI

Contributor: Jared Scott, MD Educational Pearls: EKGs look at different angles, or vectors, of the heart's electrical conduction as it travels through the heart. Knowing how to read these vectors is ...

11 Jan 20214min

Podcast 628: ST Elevation

Podcast 628: ST Elevation

Contributor: Peter Bakes, MD Educational Pearls: STEMI criteria is not just 1mm elevation in contiguous leads 1.5 mm in V2-V3 for women 2.0 mm in V2-V3 for men 2.5 mm in V2-V3 for men under 40 In...

5 Jan 20215min

Podcast 627: Oxygen Like It's Hot

Podcast 627: Oxygen Like It's Hot

Contributor: Aaron Lessen, MD Educational Pearls: High flow nasal cannula (HFNC) has become more utilized with COVID pandemic Multiple studies have shown this method improves both oxygenation and ven...

4 Jan 20213min

Populært innen Vitenskap

fastlegen
tingenes-tilstand
rekommandert
jss
rss-rekommandert
rss-nysgjerrige-norge
villmarksliv
forskningno
sinnsyn
rss-paradigmepodden
fjellsportpodden
vett-og-vitenskap-med-gaute-einevoll
nordnorsk-historie
smart-forklart
rss-overskuddsliv
diagnose
abid-nadia-skyld-og-skam
abels-tarn
tomprat-med-gunnar-tjomlid
aldring-og-helse-podden