Difference between revisions of "Epileptic Emergency Treatment"
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| − | 1. | + | 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 | + | • If he has diabetes he’s probably hyperglycemic |
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| − | 2. | + | 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 |
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| − | 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 | ||
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| − | 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. | + | 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 | ||
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| − | 6. | + | 6. If the Seizures persist or occur again ask yourself if Diazepam worked the first time |
If YES: | If YES: | ||
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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 | ||
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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 | ||
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