Difference between revisions of "Epileptic Emergency Treatment"

Revision as of 11:07, 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

@@ Line 1: / Line 1: @@
-.	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 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
+If he is already getting KBr —> i.v. 0,9% NaCl + 5% Glucose (1:1)
-.	First Step in Treatment is '''Diazepam (0,5 mg/kg i.v.)'''
+If he has diabetes he’s probably hyperglycemic
-* 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
-If an i.v.- access isn’t possible try Diazepam rectal tubes
+Onset of action: 1-2 Minutes
-* If he isn’t getting PB already: 1 mg/kg
+If the first dose isn’t working the treatment can be repeated 2-3 times
-* If he is getting PB: 2 mg/kg
-* Onset of action: 15-20 Minutes
-OR
+If an i.v.- access isn’t possible try Diazepam rectal tubes
-'''Midazolam''' intranasal with an atomizer (0,2 mg/kg)
+If he isn’t getting PB already: 1 mg/kg
-* Onset of action: 1-5 Minutes
+If he is getting PB: 2 mg/kg
+Onset of action: 15-20 Minutes
-.	Next Step: '''Phenobarbital (10 mg/kg i.v.)'''
+OR
-* Give PB even if Diazepam worked, because the effect of Diazepam will only last for 20-30 minutes
+Midazolam intranasal with an atomizer (0,2 mg/kg)
-* 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!'''
+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
-.	If the seizures persist or occure again within the next '''2''' hours: '''Levetiracetam (20 mg/kg slowly i.v.)'''
+Can be repeated once if the patient isn’t already getting PB
-* Can be repeated 2 times
+Onset of action: 15-20 Minutes
+CAVE: If the Patient is already getting PB always check the blood level before treating him with PB!
-.	Start '''Diagnostics'''
+.    If the seizures persist or occure again within the next 2 hours: Levetiracetam (20 mg/kg slowly i.v.)
-* Hypoglycemia: 3-5 ml/kg 20% Glucose i.v.
+Can be repeated 2 times
-* 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
+.    Start Diagnostics
-.	If the Seizures persist or occur again ask yourself if Diazepam worked the first time
+Hypoglycemia: 3-5 ml/kg 20% Glucose i.v.
-If '''YES''':
+Hypocalcemia: 0,5 – 1 ml/kg 10% Ca-Carbonat slowly i.v. (CAVE: Bradycardia)
-'''Diazepam'''
+Temperature: > 40 degree Celcius —> cool him down
-* 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
+    < 39,5 degree Celcius —> stop or will cool down too much
-If '''NO''':
+.    If the Seizures persist or occur again ask yourself if Diazepam worked the first time
-'''Pentobarbital'''
+If YES:
-* 1-2 mg/kg i.v. Bolus followed by…
-* 1-5 mg/kg/h continous infusion
-'''Propofol'''
+Diazepam
-* 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!'''
+,5 mg/kg i.v. Bolus followed by…
-'''Inhalation anaesthesia '''
+,1 – 0,5 mg/kg/h  (continous infusion), 30 mg Diazepam in 250 ml 5% Glucose
-Simultaneous to all 3 of them: PB on maintenance dose of 2,5 mg/kg i.m. (2x/day)
+If it works reduce Diazepam in 6-8 hours
-Wake the patient up after 6-8 hours
-{{#ev:soundcloud|https://soundcloud.com/laura-nipperdey/how-to-save-a-life-epilepsy-version}}
+If it doesn’t work put him under anaesthesia
+If NO:
-Step one, you say we need to talk
+Pentobarbital
-Two things, you ask, be quick, keep it short
+-2 mg/kg i.v. Bolus followed by…
-Thirst you really must be sure
+-5 mg/kg/h continous infusion
-If the dog has had seizures before
+Propofol
-So listen up, cause if he did
+-8 mg/kg i.v. Bolus followed by…
-Ask if he takes potassium bromid.
+-8 mg/kg/h continous infusion
-Or maybe he gets other meds
+Cave: Both those drugs can cause depression of breathing, so the patient has to be under surveillance all the time!
-For example barbiturats.
+Inhalation anaesthesia
-Now start your treatment
+Simultaneous to all 3 of them: PB on maintenance dose of 2,5 mg/kg i.m. (2x/day)
-With diazepam
+Wake the patient up after 6-8 hours
-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
-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)

Difference between revisions of "Epileptic Emergency Treatment"

Revision as of 11:07, 30 March 2021

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