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

Avsnitt(1145)

Podcast 646: Thunderclap Headache, Think...RCVS?

Podcast 646: Thunderclap Headache, Think...RCVS?

Contributor: Aaron Lessen, MD Educational Pearls: When evaluating a thunderclap headache, don't forget RCVS! RCVS: reversible cerebral vasoconstriction syndrome Due to reversible spasms of cerebra...

8 Mars 20213min

Podcast 645: Necrotizing Enterocolitis and More

Podcast 645: Necrotizing Enterocolitis and More

Contributor:  Peter Bakes, MD Educational Pearls: Necrotizing Enterocolitis (NEC) Presents in the first few days of life (often in the NICU) to 3 weeks old Risk factors include prematurity, excess ...

2 Mars 20219min

Podcast 644: Covid Outcomes

Podcast 644: Covid Outcomes

Contributor: Aaron Lessen, MD Educational Pearls: Meta-analysis of 57,420 COVID+ patients evaluated mortality after intubation 45% mortality rate for all patients in the study 84.4% mortality in p...

1 Mars 20213min

Podcast 643: Convulsions with Gastroenteritis

Podcast 643: Convulsions with Gastroenteritis

Contributor: Jared Scott, MD Educational Pearls: Differential Diagnosis: non-accidental trauma, febrile seizure, meningitis, hyponatremia, epilepsy Convulsions with gastroenteritis is a known entity...

23 Feb 20215min

Podcast 642: Vasopressors

Podcast 642: Vasopressors

Contributor: Nick Tsipis, MD Educational Pearls: Epinephrine: alpha-1, alpha-2, beta-1, and beta 2 agonist - used in cardiac arrest with positive effects on ROSC in prehospital and peri-hopsital set...

22 Feb 20218min

Podcast 641: Leadless Intracardiac Pacemaker

Podcast 641: Leadless Intracardiac Pacemaker

Contributor: Jared Scott, MD Educational Pearls: Small capsule pacemaker (2.5 cm, 1 ml volume) resides in the heart without any associated wires or leads like a traditional pacemaker The new version ...

16 Feb 20216min

Podcast 640: Kawasaki's Disease

Podcast 640: Kawasaki's Disease

Contributor: Peter Bakes , MD Educational Pearls: Pediatric Fever + Rash Differential: scarlet fever, measles, rubella, chicken pox, fifth's disease, HHV-6, adenovirus, anaphylaxis, Kawasaki's diseas...

15 Feb 20215min

Pharmacy Phriday #9: Xofluza (Baloxavir marboxil) for Influenza

Pharmacy Phriday #9: Xofluza (Baloxavir marboxil) for Influenza

Contributor: Rachael Duncan, PharmD BCPS Educational Pearls:  According to the Department of Public Health and Environment who puts out a weekly report on the influenza virus in Colorado, there appea...

12 Feb 202112min

Populärt inom Vetenskap

p3-dystopia
dumma-manniskor
svd-nyhetsartiklar
allt-du-velat-veta
det-morka-psyket
kapitalet-en-podd-om-ekonomi
pojkmottagningen
sexet
rss-ufo-bortom-rimligt-tvivel
rss-vetenskapsradion-2
rss-vetenskapsradion
dumforklarat
halsorevolutionen
rss-broccolipodden-en-podcast-som-inte-handlar-om-broccoli
medicinvetarna
rss-experimentet
bildningspodden
vetenskapsradion
hacka-livet
intergalaktiskt