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− | 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? |
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− | Does the patient have diabetes and is taking insulin? | |
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| 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) |
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− | If he isn’t getting KBr —> i.v. full electrolyte infusion | + | • If he has diabetes he’s probably hyperglycemic |
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− | If he is already getting KBr —> i.v. 0,9% NaCl + 5% Glucose (1:1)
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− | If he has diabetes he’s probably hyperglycemic
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− | 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 |
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− | If the first dose isn’t working the treatment can be repeated 2-3 times | |
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| 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 | |
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− | Onset of action: 15-20 Minutes | |
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| OR | | OR |
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| 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: 1-5 Minutes
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− | 3. Next Step: Phenobarbital (10 mg/kg i.v.)
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− | Give PB even if Diazepam worked, because the effect of Diazepam will only last for 20-30 minutes
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− | Can be repeated once if the patient isn’t already getting PB
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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 |
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| 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! |
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− | 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 |
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− | 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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− | 5. Start Diagnostics
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− | Hypoglycemia: 3-5 ml/kg 20% Glucose i.v.
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− | Hypocalcemia: 0,5 – 1 ml/kg 10% Ca-Carbonat slowly i.v. (CAVE: Bradycardia)
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− | Temperature: > 40 degree Celcius —> cool him down
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− | < 39,5 degree Celcius —> stop or will cool down too much
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− | 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 |
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| 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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− | 0,5 mg/kg i.v. Bolus followed by…
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− | 0,1 – 0,5 mg/kg/h (continous infusion), 30 mg Diazepam in 250 ml 5% Glucose
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− | If it works reduce Diazepam in 6-8 hours
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− | If it doesn’t work put him under anaesthesia
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| If NO: | | If NO: |
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| 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 |
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− | 1-5 mg/kg/h continous infusion | |
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| 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 |
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− | 4-8 mg/kg/h continous infusion | |
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| 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! |
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− | Inhalation anaesthesia | + | Inhalation anaesthesia |
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− | Simultaneous to all 3 of them: PB on maintenance dose of 2,5 mg/kg i.m. (2x/day)
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− | 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 |