Commit 4f2eae96 by deepthought

update status article

1 parent 23db7273
Showing with 37 additions and 7 deletions
......@@ -33,50 +33,79 @@ one of the following:
## treatment
### step 1 = 1st line fast-onset/short-acting = benzos
### stabilization
* can use ativan or midazolam
* assess airway, breathing circulation
* oxygen
* cardiac monitoring w telemetry
* fingerstick glucose
* if fingerstick < 60 mg/dl then:
* adults 100mg thiamine IV then 50mL D50W IV
* children &ge; 2 years: 2 ml/kg D25W IV & children < 2 years: 4 ml/kg 12.5W
* basic labs (electrolytes, CBC, tox screen, if relevant ASD levels)
### ASD step 1 = 1st line fast-onset/short-acting = benzos
* can use ativan IV, diazepam IV, or midazolam IM
* lorazepam = ativan IV
* adult: 0.1mg/kg
* peds: 0.05-0.5mg/kg
* rate: 2mg/min
* max recommended for adult & peds = 4mg. may repeat in ~5-10min
* max recommended for adult & peds = 4mg. may repeat in ~5-10min (some sources state only repeat once, eg. Glauser et al.)
* midazolam IM
* 13-40kg: 5mg
* >40kg: 10mg
* (some sources state use single dose, e.g. Glauser et al.)
* diazepam IV
* 0.15-0.2mg/kg/dose
* max 10mg/dose
* can repeat once
### step 2 = 1st line longer-acting anti-seizure drug (semantics/convention: sometimes called 2nd line)
* if not of above available:
* IV phenobarbital 15 mg/kg/dose
* rectal diazepam 0.2-0.5mg/kg, max 20mg/dose
* midazolam: intranasal, buccal
### ASD step 2 = 1st line longer-acting anti-seizure drug (semantics/convention: sometimes called 2nd line)
* fosphenytoin or phenytoin IV
* adults & peds: 18-20mg/kg
* adults & peds: 20mg/kg (some state 18-20mg/kg)
* max 1500mgPE/dose
* rate: fosphenytoin 150mg/min or phenytoin 50mg/min
* effective ~10-30min after admin
* valproate as alternative
* load: 20-25mg/kg IV
* max 3000mg/dose
* rate: adults: 3-6mg/kg/min & peds 1.5-3mg/kg/min
* levetiracetam (keppra)
* load ~1.5g (~1-3g per uptodate) at 2-5 mg/kg/mins
* others, e.g. Glauser et al., cite 60mg/kg with max 4500mg/dose
* if above not available:
* IV phenobarbital 15mg/kg
*note: levetiracetam (keppra) & lacosamide not recommended as 1st/2nd line agents for status
* however keppra is nonetheless widely used given relatively favorable side effect profile
### step 3 if warranted - repeat another dose of the same longer-acting ASD
### ASD step 3 if warranted - repeat another dose of the same longer-acting ASD
* may bolus ~1/3 prior dose (i.e. phenytoin or valproate)
* can give ~5-10mg/kg
* note: while not in formal algorithms, in practice another agent might be considered (i.e. if initially gave keppra, might then try phenytoin if hemodynamically stable)
### step 4 if warranted - sedatives/anesthetics
### ASD step 4 if warranted - sedatives/anesthetics
* consider intubation / ICU and infusion of anesthetic agent:
* midazolam
* propofol
* pentobarbital
* thiopental
* treat to burst suppression for 12-48 hrs
* then gradually withdraw w continuous EEG monitoring
......@@ -87,4 +116,5 @@ one of the following:
* uptodate.com including "Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis"
* Mayo Clinic Neurology Board Review book ISBN-13 978-0190244897
* Neurology Continuum
* Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Glauser et al. 2017 http://dx.doi.org/10.5698/1535-7597-16.1.48 http://www.epilepsycurrents.org/doi/full/10.5698/1535-7597-16.1.48?code=amep-site
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