4- Status Epilepticus - 5th year

The conventional definition of status epilepticus includes a single seizure lasting __________ or a series of seizures lasting over __________ without full recovery.

30 minutes; 30 minutes

The revised definition of generalized convulsive status epilepticus in older children refers to __________ of continuous seizure or __________ discrete seizures with incomplete recovery of consciousness.

5 minutes; > 2

Treatment for most seizures needs to be instituted after __________ of seizure activity.

5 minutes

Patients with generalized seizure activity at arrival in the ER are treated __________ of prior duration.

promptly regardless

If appropriate therapy is delayed, status epilepticus can cause permanent neurologic __________ or __________.

sequelae; death

A child who presents actively convulsing should be assumed to have __________.

status epilepticus

One of the causes of status epilepticus is __________.

fever

__________ is a key inhibitory neurotransmitter involved in the pathophysiology of status epilepticus.

GABA

In phase 1 of status epilepticus (0-30 min), compensatory mechanisms remain intact, characterized by increased __________ and __________ .

cerebral blood flow (CBF); metabolism

During phase 2 of status epilepticus (>30 min), compensatory mechanisms start to fail, leading to __________ and __________ .

cerebral edema; respiratory depression

The longer status epilepticus persists, the __________ the likelihood of spontaneous cessation.

lower

Mortality rates for status epilepticus in adults range from __________ to __________ .

15%; 22%

The emergency management of status epilepticus should prioritize maintenance of adequate __________, __________, and __________ .

airway; breathing; circulation

Before any medications are given for status epilepticus, it is essential to obtain a brief __________ .

history

Initial investigations for status epilepticus may include checking blood levels of __________, __________, and __________ .

sodium (Na); calcium (Ca); magnesium (Mg)

A lumbar puncture should be deferred in unstable patients but should not delay what type of treatment if indicated? __________

antibiotic/antiviral

Rapid acting anticonvulsants include __________ and __________ .

benzodiazepines; diazepam

The recommended dose of lorazepam for status epilepticus is __________ mg/kg IV over 1-2 minutes.

0.1

In status epilepticus management, diazepam may be repeated every __________ to __________ minutes if seizure persists.

5; 10

The preferred first agent for treating refractory status epilepticus is __________.

midazolam

Phenobarbital is the drug of choice for neonates with __________ .

status epilepticus

Increased heart rate and blood pressure are usually seen in the __________ patient but return to normal once the convulsion is stopped.

convulsing

Management of the airway in a convulsing patient may involve __________ the patient on their side.

positioning

Patients showing signs of bradycardia, hypotension, and poor perfusion may imply __________ and the need to establish the airway.

hypoxia

If status epilepticus is suspected, it is essential to search for __________ causes during the clinical assessment.

precipitating

Complications of status epilepticus include __________, __________, and __________ .

hypoglycemia; respiratory depression; renal failure

Side effects of phenytoin include purple glove syndrome which causes discoloration around the __________ site.

IV

Therapeutic levels for total phenytoin range between __________ and __________ mcg/ml.

10; 20

The maximum total dose of phenytoin that may be given is __________ mg/kg.

30

If seizure continues after initial doses of long-acting anticonvulsants, an additional __________ mg/kg of phenytoin may be administered.

5

A rectal dose of diazepam typically reaches anticonvulsant levels in __________ to __________ minutes.

5; 10

For management of ongoing seizures, __________ infusion is indicated if previous medications have not been effective.

midazolam

Fosphenytoin has a pH level of __________ and is better tolerated for extravasation compared to phenytoin.

8.6

In the presence of increased ICP, this condition must be treated prior to __________ .

investigation

If no seizures occur for __________ hours, reduce midazolam by 1 microgram/kg/min every 15 minutes.

24

Signs of increased ICP that must be handled before investigation include __________ and __________ .

hypertension; seizures

Among new drugs for status epilepticus, __________ is available in IV form.

valproate

In acute settings of status epilepticus, a long-acting anticonvulsant should follow the first dose of __________ .

benzodiazepine

Children from 3 to 15 years of age often see mortality rates in status epilepticus estimated between __________ to __________ percent.

3; 15