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Epileptic Emergency Treatment (view source)
Revision as of 16:38, 8 April 2021
, 16:38, 8 April 2021I added the source of the treatment plan
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?
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
If he isn’t getting KBr —> i.v. full electrolyte infusion
6. If the Seizures persist or occur again ask yourself if Diazepam worked the first time
If he is already getting KBr —> i.v. 0,9% NaCl + 5% Glucose (1:1)
If '''YES''':
If he has diabetes he’s probably hyperglycemic
'''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
{{#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 YES:
If it still does not improve
Breath in, breath out and make another move
Try Levetiracetam
Next step would be Diazepam
If it works reduce Diazepam in 6-8 hours
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
He’s save for now and he will be
But still you should stay up with him all night
And that is how to save a life
Based on the treatment plan by Prof. Dr. Thomas Flegel (University of Leipzig, Germany)