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martes, 9 de mayo de 2017

Status epilepticus

PulmCrit (EMCrit)
PulmCrit - May 8, 2017 - By Josh Farkas
  • "Ongoing generalized convulsive seizures are an immediate life-threat that may cause brain damage, aspiration, rhabdomyolysis, hyperkalemia, arrhythmia, and hyperthermia.
  • A streamlined algorithm is proposed to achieve rapid seizure control using immediately available medications.
  • Patients who fail to respond to benzodiazepine will frequently require intubation and sedative infusion to control their seizures. Early intubation in these patients may expedite seizure control and avoid complications.
  • Propofol and ketamine are powerful anti-epileptic agents. Emerging evidence suggests that they work synergistically by affecting GABA and NMDA receptors, respectively.
  • The best conventional anti-epileptic agent is unknown and currently under investigation in the ESSET trial. Fosphenytoin has the most side-effects, so for now  evtiracetam or valproic acid seem like the best choices."