20 min listen
Episode 82.0 – ED Management of Seizures
Episode 82.0 – ED Management of Seizures
ratings:
Length:
20 minutes
Released:
Jan 30, 2017
Format:
Podcast episode
Description
This week we discuss the ED management of seizures focusing on treatment and workup particularly of a 1st seizure episode.
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Tags: Neurology, Seizure, Status Epilepticus
Show Notes
Take Home Points
Get a detailed history to tease out whether the patient had a seizure or a syncopal event. Regardless, get an EKG on 1st time seizures in case it was actually syncope.
BZDs are first line therapy for seizure termination. If you don’t have IV access, go with 10 mg of midazolam or 2-4 mg of lorazepam IM
Always review the 5 main categories for causes of seizures in order to make sure you’re not missing anything. Those categories once again are vital sign abnormalities, CNS infections, toxic/metabolic issues, CNS space occupying lesions including masses and bleeds and finally epilepsy.
In patients with a first time seizure without a particular cause and return to baseline neurologic status, there’s unlikely to be any benefit to a NCHCT or to starting an AED. Scheduling close follow up with a neurologist is very reasonable. The key is to do a thorough examination and make sure you’re not missing a subtle abnormality.
Finally, in status epilepticus hit the patient with 2-3 hefty doses of BZDs and if the seizure is still ongoing, strongly consider moving to propofol and intubation in order to rapidly control the seizure activity.
Released:
Jan 30, 2017
Format:
Podcast episode
Titles in the series (100)
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