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Epileptic Emergency Treatment (view source)
Revision as of 11:12, 30 March 2021
, 11:12, 30 March 2021no edit summary
1. Ask the Owner 2 questions
1. 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?
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
2. First Step in Treatment is Diazepam (0,5 mg/kg i.v.)
2. First Step in Treatment is Diazepam (0,5 mg/kg i.v.)
• Onset of action: 1-2 Minutes
Onset of action: 1-2 Minutes
• If the first dose isn’t working the treatment can be repeated 2-3 times
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 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
• Onset of action: 15-20 Minutes
If he is getting PB: 2 mg/kg
Onset of action: 15-20 Minutes
OR
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: 15-20 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!
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.)
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
6. 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…
• 0,1 – 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:
If NO:
Pentobarbital
Pentobarbital
• 1-2 mg/kg i.v. Bolus followed by…
1-2 mg/kg i.v. Bolus followed by…
• 1-5 mg/kg/h continous infusion
1-5 mg/kg/h continous infusion
Propofol
Propofol
• 4-8 mg/kg i.v. Bolus followed by…
4-8 mg/kg i.v. Bolus followed by…
• 4-8 mg/kg/h continous infusion
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!
Cave: Both those drugs can cause depression of breathing, so the patient has to be under surveillance all the time!
Inhalation anaesthesia
Inhalation anaesthesia
Wake the patient up after 6-8 hours
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