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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, September 14, 2015

RST del estado epiléptico

PulmCrit - June 4, 2014

The duration of time which it is safe to leave a patient in generalized convulsive status epilepticus is unknown. Until this is clarified, it may be safer to err on the side of caution and avoid periods of status epilepticus longer than 30 minutes.   
Rapid sequence termination is a simple approach to achieve seizure control very rapidly. This is a true emergency, and waiting for drugs to arrive from the pharmacy or praying that the third-line antiepileptic works may not be the best approach. Instead, RST allows you to take control of the situation and break the seizure quickly. This also reduces the time delay to neuroimaging, lumbar puncture, EEG, and other components of patient care which will be ignored during the seizure itself.  
Neurologists and ED/ICU physicians have different perspectives on intubation. From a neurology standpoint, intubation may be viewed as a failure of antiepileptic treatment to work. From an ED/ICU standpoint, intubation is more likely to be viewed as an essential step to stabilize the patient and facilitate definitive therapy.
Unfortunately, status epilepticus is very difficult to study due to its emergent and infrequent nature. There are only a handful of randomized controlled trials available, and many important questions remain unanswered. Although we believe that RST is a reasonable approach, in the absence of data there are a broad range of approaches which are equally reasonable. We are not the first clinicians to propose this streamlined approach of intubation and propofol infusion for patients failing to respond to benzodiazepine (
Marik 2004). Ultimately it is up to the bedside clinician to determine which strategy makes the most sense for any given patient given the circumstances and available resources."