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(1146)

Podcast # 431: Medication Errors

Podcast # 431: Medication Errors

Author: Rachel Brady, MD Educational Pearls: Medication errors are estimated to be the 3rd leading cause of death A 2016 study estimated 250,000 errors occur per year, with 7000-9000 leading to death...

4 Feb 20193min

Podcast # 430: Humeral IO

Podcast # 430: Humeral IO

Author: Aaron Lessen, MD Educational Pearls: Choose the longest needle for the humeral IO Internally rotate and adduct the patients hand (resting on umbilicus) for best access to the site Aim 1 cm su...

30 Jan 20193min

Podcast # 429: Oldschool Syphilis Treatment

Podcast # 429: Oldschool Syphilis Treatment

Author: Chris Holmes, MD Educational Pearls: In WWI, the 2nd leading cause of soldier disability were STDs. An early treatment of syphilis included topical and inhaled mercury Bloodletting, vitriol, ...

28 Jan 20194min

Podcast # 428: Severe Hypothyroidism

Podcast # 428: Severe Hypothyroidism

Author: Gretchen Hinson, MD Educational Pearls: Clinical manifestations of severe hypothyroidism may include: Pale, cool, diaphoretic skin Myxedema is the non-pitting edema seen in hypothyroidism Hy...

27 Jan 20193min

Podcast # 427: Cookie Dough is Delicious

Podcast # 427: Cookie Dough is Delicious

Author: Eric Miller, MD Educational Pearls: Recent CDC statement warms against consumption of cookie dough Two common ingredients can pose risk: eggs and flour Flour in dough is a raw agricultural ...

24 Jan 20192min

Podcast # 426: Ho Ho - Oh No!

Podcast # 426: Ho Ho - Oh No!

Author: Katrina Iverson, MD Educational Pearls: The winter holiday months present a unique picture of patient presentations to the emergency department Some of the unique presentations include: Chi...

22 Jan 20192min

Podcast # 425: Oseltamivir Efficacy in Children

Podcast # 425: Oseltamivir Efficacy in Children

Author: Aaron Lessen, MD Educational Pearls: Recent meta-analysis reviewed efficacy oseltamivir (Tamiflu) in pediatric populations treated for influenza, showing an 18 hour reduction in duration of i...

18 Jan 20193min

Podcast # 424: Hunting for Measles

Podcast # 424: Hunting for Measles

Author: Mike Hunt, MD Educational Pearls: Measles is highly contagious and successfully infects 90% of those at risk exposed to the virus. 10 day prodrome where patients are asymptomatic. 3 day perio...

16 Jan 20194min

Populärt inom Vetenskap

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