Seizure and Status Epilepticus Emergency Department Patient Guidelines is presented by Edward Sloan, MD, MPH, emergency department physician and FERNE President.
The Foundation for the Education and Research in Neurological Emergencies (FERNE) is an independent not-for-profit organization committed to the following principles:
1. Patients with neurologic emergencies deserve quality emergency care.
2. The emergency care for neurologic emergencies can be enhanced through quality scientific research.
3. Emergency medical care providers can provide optimal medical care for patients with neurological emergencies through participation in quality medical education that highlights state-of-the-art neurologic care.
Go to FERNE.org to learn more and participate.
0:00 Introduction
0:01 Seizure and Status Epilepticus Patient Guidelines: A Simple Clinical Pathway
0:32 Dominican University River Forest, IL
2:03 Review the American Epilepsy Society (AES) Guideline for the Treatment of Convulsive Status Epilepticus. • Understand the ACEP Clinical Policy for ED seizure patient management. Update SE treatment based on AES Rx convulsive SE publication.
2:31 Few valid clinical trials establishing clinical efficacy of one specific anti- epileptic drug over another • Case series exist that give guidance Clinical policies provide options
3:39 2016 AES Status Epilepticus Guideline
5:14 Clinical Setting Interventions for Emergency Department, in-patient setting, or pre-hospital setting with trained paramedics
5:30 5 minutes Stabilization phase
5:40 Stabilize patient (airway, breathing, circulation, disability - neurologic exam) 2. Time seizure from its onset & monitor vital signs 3. Assess oxygenation, give oxygen via nasal cannula/mask, consider intubation i respiratory assistance needed
6:20 Initiate ECG monitoring 5. Collect finger stick blood glucose. If glucose 60 mg/dl, then Adults: 100 mg thiamine IV, 50 ml D50W IV Children 2 2 years: 2 ml/kg D25W IV Children 2 years: 4 ml/kg D12.5W IV
7:01 Attempt IV access and collect electrolytes, hematology, toxicology screen, (if appropriate) anticonvulsant drug levels
7:46 A benzodiazepine is the initial therapy of choice (Level A): Choose one of the following 3 equivalent first line options with dosing and frequency
18:35 Emergency physicians need not initiate antiepileptic medication* in the ED for patients who have had a first
19:48 Emergency physicians may initiate antiepileptic medication in the ED, or defer in coordination with other
22:17 3. In patients with a known seizure disorder in which resuming their antiepileptic medication in the ED is deemed appropriate, does the route of administration impact recurrence of seizures?
23:51 In ED patients with generalized convulsive status epilepticus who continue to have seizures despite receiving optimal dosing of a benzodiazepine, which agent or agents should be administered next to terminate seizures?
30:46 A new AES guideline published 22 years after the initial EFA SE guideline uses a three phase times approach to Rx. • ACEP 2014 Clinical Policy provides Rx strategies for relevant clinical questions. • Similar options for SE Rx are provided in the ACEP Clinical Policy. • 2020 AES info confirms SE Rx uncertainty but does identify similar best options.
27 апр 2023
