Status Epilepitcus

Question 1

Characterize phase I SE

Answer 1

1. Increased epinephrine/norepinephrine –> HTN, tachycardia, arrhythmias
2. Muscle contractions and hypoxia
   - Acidosis
   - Hypotension (shock)
   - Rhabdomyolysis (with secondary hyperkalemia)
   - Acute tubular necrosis

Question 2

Characterize phase II SE

Answer 2

-Begins 30 minutes into a seizure
1. Decompensation
2. Glucose decrease
3. Hyperthermia
(ventilatory failure, maybe)

Question 3

Treatment of impending GCSE (0-30 minutes)

Answer 3

Lorazepam (Ativan)***

Question 4

Treatment in Established GCSE (30-60 minutes)

Answer 4

Hydantoins (ex. phenytoin, fosphenytoin)

Question 5

When is GCSE not controlled/refractory?

Answer 5

if not controlled by 2 anticonvulsants

Question 6

What is the third drug given for GCSE when it becomes refractory (> 120 minutes)

Answer 6

• Midazolam
• Pentobarbital
• Propofol (only active while infusing)

Question 7

What are the final options for Super-Refractory GCSE?

Answer 7

• Ketamine
• Hypothermia
• Lidocaine
• Topiramate
• corticosteroids

Question 8

What are the 3 ways Midazolam can be given?

Answer 8

• Buccal
• Intranasal
• IV or IM