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Status Epilepticus

Status Epilepticus. Case Studies Kassandra Barkley, ANP-BC. Case Study.

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Status Epilepticus

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  1. Status Epilepticus Case Studies Kassandra Barkley, ANP-BC

  2. Case Study • 71-year-old woman with lung cancer w/ brain metastasis, diabetes 2, hypertension, coronay artery dz who presents with altered mental status. Patient was severely altered with spontaneous movements of all 4 exts. PERRL bilat. Withdraws all extremities to pain.

  3. What would you do in the first 5 mins? • Give 2mg Ativan IV • Send labs (CBC, CBC, LFTs, ABGs, urine/tox screen, Mg, PO4, Ca, troponins, coag studies.) C. Stat neurology consult & order continuous EEG • ABCs, IV access, check finger stick glucose, treat low or unknown glucose w/ thiamine & dextrose • ALL OF THE ABOVE

  4. Case Study • Within 1st 5 mins: • ABCs • IV access (preferably 2 sites) • Check blood glucose (it was 58) • Administer thiamine, dextrose • Continuous monitoring (telemetry, HR, BP, O2) • Send labs --->CBC, BMP, ABGs, urine/blood tox screen, Mg, PO4, Ca, troponins, coag studies • Ativan 2mg IV • Stat neuro consult, continuous EEG monitoring

  5. EEG hooked up & showing multifocal seizures, still occurring after 10 mins. Oxygen 95%, HR 102, BP 144/80, temp 99. What next? A. Give Pentobarbital loading followed by maintenance dosing B. Load with Fosphenytoin C. Give Ativan 2mg IV D. Rapid intubation with initiation of Midazolam E. A and B are correct F. B and C are correct

  6. Ativan 2mg IV and Fosphenytoin loading. BP 152/90, HR 109, Oxygen 94%, Temp 99.1.After 10 mins EEG still showing multifocal seizures. WHAT NEXT? • Initiate IV pentobarbital infusion • Load with IV Valproic Acid • Initiate IV Ketamine infusion • Initiate IV Propofol infusion

  7. Case Study • 10 minutes later IV Valproic Acid Loading which finally stopped the seizures. • No sedation was needed.

  8. ROUTINE 20 MINUTE EEG IS THE BEST WAY TO MONITOR PATIENTS FOR SEIZURE ACTIVITY IN THE ICU? • True • False

  9. SEIZURES ARE ALWAYS OBVIOUS AND EASY TO RECOGNIZE? • True • False

  10. Status should be treated within 4 hours? • True • False

  11. It is ok to interpret EEGs yourself if you feel comfortable doing so? • True • False

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