Difference between revisions of "Epileptic Emergency Treatment"

Revision as of 11:12, 30 March 2021

1. Ask the Owner 2 questions • Is the patient a known epilepticer who’s getting KBr or Phenobarbital (PB)? • Does the patient have diabetes and is taking insulin?

Why is that relevant? • If he isn’t getting KBr —> i.v. full electrolyte infusion • If he is already getting KBr —> i.v. 0,9% NaCl + 5% Glucose (1:1)

• If he has diabetes he’s probably hyperglycemic

2. First Step in Treatment is Diazepam (0,5 mg/kg i.v.) • Onset of action: 1-2 Minutes • If the first dose isn’t working the treatment can be repeated 2-3 times

If an i.v.- access isn’t possible try Diazepam rectal tubes • If he isn’t getting PB already: 1 mg/kg • If he is getting PB: 2 mg/kg • Onset of action: 15-20 Minutes

OR

Midazolam intranasal with an atomizer (0,2 mg/kg) • Onset of action: 1-5 Minutes

3. Next Step: Phenobarbital (10 mg/kg i.v.) • Give PB even if Diazepam worked, because the effect of Diazepam will only last for 20-30 minutes • Can be repeated once if the patient isn’t already getting PB • Onset of action: 15-20 Minutes

CAVE: If the Patient is already getting PB always check the blood level before treating him with PB!

4. If the seizures persist or occure again within the next 2 hours: Levetiracetam (20 mg/kg slowly i.v.) • Can be repeated 2 times

5. Start Diagnostics • Hypoglycemia: 3-5 ml/kg 20% Glucose i.v. • Hypocalcemia: 0,5 – 1 ml/kg 10% Ca-Carbonat slowly i.v. (CAVE: Bradycardia) • Temperature: > 40 degree Celcius —> cool him down

    < 39,5 degree Celcius —> stop or will cool down too much

6. If the Seizures persist or occur again ask yourself if Diazepam worked the first time

If YES: Diazepam • 0,5 mg/kg i.v. Bolus followed by… • 0,1 – 0,5 mg/kg/h (continous infusion), 30 mg Diazepam in 250 ml 5% Glucose • If it works reduce Diazepam in 6-8 hours • If it doesn’t work put him under anaesthesia

If NO:

Pentobarbital • 1-2 mg/kg i.v. Bolus followed by… • 1-5 mg/kg/h continous infusion

Propofol • 4-8 mg/kg i.v. Bolus followed by… • 4-8 mg/kg/h continous infusion

Cave: Both those drugs can cause depression of breathing, so the patient has to be under surveillance all the time!

Inhalation anaesthesia

 Simultaneous to all 3 of them: PB on maintenance dose of 2,5 mg/kg i.m. (2x/day)  Wake the patient up after 6-8 hours

Difference between revisions of "Epileptic Emergency Treatment"

Revision as of 11:12, 30 March 2021

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-.	Ask the Owner '''2 questions'''
+.	Ask the Owner 2 questions
+•	Is the patient a known epilepticer who’s getting KBr or Phenobarbital (PB)?
-* Is the patient a known epilepticer who’s getting KBr or Phenobarbital (PB)?
+•	Does the patient have diabetes and is taking insulin?
-* Does the patient have diabetes and is taking insulin?
 Why is that relevant?
+•	If he isn’t getting KBr —> i.v. full electrolyte infusion
+•	If he is already getting KBr —> i.v. 0,9% NaCl + 5% Glucose (1:1)
-* If he isn’t getting KBr —> i.v. full electrolyte infusion
+•	If he has diabetes he’s probably hyperglycemic
-* If he is already getting KBr —> i.v. 0,9% NaCl + 5% Glucose (1:1)
-* If he has diabetes he’s probably hyperglycemic
-.	First Step in Treatment is '''Diazepam (0,5 mg/kg i.v.)'''
-* Onset of action: 1-2 Minutes
+.	First Step in Treatment is Diazepam (0,5 mg/kg i.v.)
-* If the first dose isn’t working the treatment can be repeated 2-3 times
+•	Onset of action: 1-2 Minutes
+•	If the first dose isn’t working the treatment can be repeated 2-3 times
 If an i.v.- access isn’t possible try Diazepam rectal tubes
+•	If he isn’t getting PB already: 1 mg/kg
-* If he isn’t getting PB already: 1 mg/kg
+•	If he is getting PB: 2 mg/kg
-* If he is getting PB: 2 mg/kg
+•	Onset of action: 15-20 Minutes
-* Onset of action: 15-20 Minutes
 OR
-'''Midazolam''' intranasal with an atomizer (0,2 mg/kg)
+Midazolam intranasal with an atomizer (0,2 mg/kg)
+•	Onset of action: 1-5 Minutes
-* Onset of action: 1-5 Minutes
-.	Next Step: '''Phenobarbital (10 mg/kg i.v.)'''
-* Give PB even if Diazepam worked, because the effect of Diazepam will only last for 20-30 minutes
-* Can be repeated once if the patient isn’t already getting PB
-* Onset of action: 15-20 Minutes
-'''CAVE: If the Patient is already getting PB always check the blood level before treating him with PB!'''
+.	Next Step: Phenobarbital (10 mg/kg i.v.)
+•	Give PB even if Diazepam worked, because the effect of Diazepam will only last for 20-30 minutes
+•	Can be repeated once if the patient isn’t already getting PB
+•	Onset of action: 15-20 Minutes
+CAVE: If the Patient is already getting PB always check the blood level before treating him with PB!
+.	If the seizures persist or occure again within the next 2 hours: Levetiracetam (20 mg/kg slowly i.v.)
+•	Can be repeated 2 times
-.	If the seizures persist or occure again within the next '''2''' hours: '''Levetiracetam (20 mg/kg slowly i.v.)'''
+.	Start Diagnostics
+•	Hypoglycemia: 3-5 ml/kg 20% Glucose i.v.
+•	Hypocalcemia: 0,5 – 1 ml/kg 10% Ca-Carbonat slowly i.v. (CAVE: Bradycardia)
+•	Temperature: > 40 degree Celcius —> cool him down
+     < 39,5 degree Celcius —> stop or will cool down too much
-* Can be repeated 2 times
-.	Start '''Diagnostics'''
-* Hypoglycemia: 3-5 ml/kg 20% Glucose i.v.
-* Hypocalcemia: 0,5 – 1 ml/kg 10% Ca-Carbonat slowly i.v. (CAVE: Bradycardia)
-* Temperature: > 40 degree Celcius —> cool him down < 39,5 degree Celcius —> stop or will cool down too much
 .	If the Seizures persist or occur again ask yourself if Diazepam worked the first time
-If '''YES''':
+If YES:
+Diazepam
-'''Diazepam'''
+•	0,5 mg/kg i.v. Bolus followed by…
-* 0,5 mg/kg i.v. Bolus followed by…
+•	0,1 – 0,5 mg/kg/h  (continous infusion), 30 mg Diazepam in 250 ml 5% Glucose
-* 0,1 – 0,5 mg/kg/h  (continous infusion), 30 mg Diazepam in 250 ml 5% Glucose
+•	If it works reduce Diazepam in 6-8 hours
-* If it works reduce Diazepam in 6-8 hours
+•	If it doesn’t work put him under anaesthesia
-* If it doesn’t work put him under anaesthesia
-If '''NO''':
-'''Pentobarbital'''
-* 1-2 mg/kg i.v. Bolus followed by…
-* 1-5 mg/kg/h continous infusion
-'''Propofol'''
-* 4-8 mg/kg i.v. Bolus followed by…
-* 4-8 mg/kg/h continous infusion
-'''Cave: Both those drugs can cause depression of breathing, so the patient has to be under surveillance all the time!'''
-'''Inhalation anaesthesia '''
-Simultaneous to all 3 of them: PB on maintenance dose of 2,5 mg/kg i.m. (2x/day)
-Wake the patient up after 6-8 hours
-{{#ev:soundcloud|https://soundcloud.com/laura-nipperdey/how-to-save-a-life-epilepsy-version}}
-Step one, you say we need to talk
-Two things, you ask, be quick, keep it short
-Thirst you really must be sure
-If the dog has had seizures before
-So listen up, cause if he did
-Ask if he takes potassium bromid.
-Or maybe he gets other meds
-For example barbiturats.
-Now start your treatment
-With diazepam
-PB is next, on the treatment plan
-And now you should stay up with him all night
-And that is how to save a life
-If it still does not improve
-Breath in, breath out and make another move
-Try Levetiracetam
-Next step would be Diazepam
-If that hasn‘t worked before
-You still got other things in store
-Anesthesia makes him sleep
-But careful that will not be cheap
-Now that’s your treatment
-Haven’t lost him yet
+If NO:
-He’s save for now and he will be
+Pentobarbital
+•	1-2 mg/kg i.v. Bolus followed by…
+•	1-5 mg/kg/h continous infusion
-But still you should stay up with him all night
+Propofol
+•	4-8 mg/kg i.v. Bolus followed by…
+•	4-8 mg/kg/h continous infusion
-And that is how to save a life
+Cave: Both those drugs can cause depression of breathing, so the patient has to be under surveillance all the time!
+Inhalation anaesthesia
-Based on the treatment plan by Prof. Dr. Thomas Flegel (University of Leipzig, Germany)
+	Simultaneous to all 3 of them: PB on maintenance dose of 2,5 mg/kg i.m. (2x/day)
+	Wake the patient up after 6-8 hours