Seizures

Question 1

Define Status Epilepticus (per this CPG).

Answer 1

≥5 minutes of continuous seizure activity OR multiple seizures without full recovery of consciousness between seizures.

Question 2

How is GCSE characterised?

Answer 2

Generalised tonic clonic movements of the extremities with altered conscious state.

Question 3

How does subtle SE develop, and what are the characteristics?

Answer 3

May develop from prolonged/uncontrolled GCSE.
Characterised by:
Coma
Ongoing electrographical seizure activity
+/- subtle convulsive movements

Question 4

When should subtle SE be suspected?

Answer 4

Consider in pts who have witnessed tonic-clonic convulsions initially and present with ongoing coma and no improvement in conscious state +/- subtle convulsive movements

Question 5

How are non-GCSE seizures managed?

Answer 5

Consult for midazolam with clinician.

Question 6

Midazolam can have pronounced effects on…

Answer 6

BP, conscious state, ventilations and airway tone.

Question 7

What note is made about midazolam in pregnancy?

Answer 7

Able to cross the placenta, can be harmful to unborn baby, however still indicated in GCSE as it is considered a life threat to both mother/child.

Question 8

When should eclampsia be suspected?

Answer 8

In pregnant patients with no Hx of seizures or who have been diagnosed with pre-eclampsia.

Question 9

What other causes should be considered in the setting of seizures?

Answer 9

1. Hypoglycaemia
2. Hypoxia
3. Head trauma
4. Stroke/ICH
5. Electrolyte disturbance
6. Meningitis

Question 10

If seizure activity has ceased, other SE or Subtle SE present, what is the management?

Answer 10

1. Monitor airway, ventilation, conscious state and BP
2. If suspected subtle SE, consider time critical transport and consult for Midazolam
3. If pt fully recovered, consider TnR

Question 11

If confirmed GCSE, what is the management?

Answer 11

1. Manage airway and ventilation as required
2. If airway patent, administer high flow O2
3. Midazolam -
   10mg IM, rpt 10mg once after 10mins if no response.
   OR
   5mg IM, rpt 5mg once after 5mins if no response
4. Consider early MICA request

Question 12

Which patients receive a reduced Midazolam dose?

Answer 12

Elderly, frail, <60kg

Question 13

If after initial Midazolam administered, what is the timeframe for re-assessment?

Answer 13

10mins for full doses, 5 mins for half doses.

Question 14

If after reassessment the pt has not responded to treatment, what are the further steps to take?

Answer 14

1. Continue to monitor airway, ventilation, BP and CS

2. Consult for further doses

Question 15

If after reassessment the pt has responded to the initial treatment, what are the further steps to take?

Answer 15

1. BLS

2. Continue to monitor airway, ventilation, conscious state and BP

Question 16

What is the benefit of an early MICA request in these patients?

Answer 16

Admin of IV Midazolam, advanced airway management.