![]() I don’t like this option in the actively seizing patient because it just takes too long (at least 20 minutes). Most published algorithms will have with phenytoin or fosphenytoin as the second-line agent. Women in their third trimester should be relatively obvious, but eclampsia can occur up to 8 weeks postpartum, so you may need to be treated empirically. If there is no response 4 minutes after the first benzo, I repeat the dose.Įclampsia must be considered in any female of childbearing age before moving on to second-line medications. If an IV has not been started, I will also often use either an IM or intranasal dose before placing an IO. Usually this first dose will have already been given before the patient arrives. It really doesn’t matter which one you pick – they all work. (Initial doses of antiepileptics can be given without an IV, for example IM or IN midazolam, but further treatment will require vascular access.) If an IV is not rapidly available, I place an IO. The management of status epilepticus will require venous access. I place nasal trumpets bilaterally and apply a non-rebreather facemask in an attempt to provide some apneic oxygenation. You don’t need to ventilate the patient immediately, but oxygen is important because the patient is burning through it very quickly. The first priority should be terminating seizure activity, because that will generally solve any airway and breathing issues. What do I do about the airway and breathing? If for some reason you are unable to get a level, just go ahead and treat empirically with D50W. The first words out of your mouth should probably be, “what’s the sugar?” Not only is it embarrassing to miss hypoglycemia, it is an easily identifiable and easily treatable etiology of status epilepticus. Unlike simple seizures, which will generally resolve without any intervention and require clinical constraint to avoid overtreatment, status epilepticus (with generalized tonic clonic seizures) is a medical emergency that requires immediate management. Please Note: A new version of this post was created in 2019. The paramedics were unable to start an IV, but did administer a dose of IM midazolam… No information is available about her past history. The seizure has been ongoing for at least 12 minutes now, so this is status epilepticus. EMS arrives with a 39 year old woman who was found down in a generalized tonic clonic seizure.
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