Monday, June 18, 2018

Refractory Status Epilepticus

emDocs - Jun 18, 2018 - Authors: DeVivo A and Beck-Esmay J
Edited by: Koyfman A and Long B
"Key Points
  • Keep a broad differential in patients who present in refractory status epilepticus and use all modalities of history available to discern and treat the most likely etiology. Small pieces of history can vastly change management.
  • Patients who require intubation and sedation should be frequently re-assessed for signs of persistent seizure activity and an EEG should be obtained as soon as possible in an intensive care setting once the initial ED workup is complete.
  • After the ABCs, one of the initial diagnostics ordered should be a point of care glucose.
  • After initial stabilization, an EKG should be performed on all patients in status epilepticus.
  • A core temperature should always be obtained.
  • Any signs of trauma should raise clinical suspicion for intracranial pathology as the etiology of the seizures.
  • History of recent febrile illness and seizures should prompt all ED staff to take appropriate precautions in order to avoid transmission of communicable disease in the event meningitis is the etiology. Provider and ED staff safety is paramount, regardless of the situation.
  • Patients with a history of seizures can easily lead to anchoring on medication noncompliance as the etiology of their status epilepticus. However, these patients can easily have multifactorial etiologies for their presentation, and caution is warranted when attributing persistent seizures to medication nonadherence."