Episode 90- PharmSoHard meets ER-Rx: Status Epilepticus
Episode Summary:
In this episode, I sit down with Jimmy Pruitt of the PharmSoHard podcast and talk about my favorite; status epilepticus.
Show Notes:
Key Points:
“PharmSoHard meets ER-Rx: Status Epilepticus”:
– For emergent therapy: IV lorazepam 0.1 mg/kg (max of 4 mg), may repeat x 1 / IM midazolam 0.2 mg/kg (max of 10 mg)/ IV diazepam 0.15 mg/kg (max of 10 mg)
– Guidelines recommend giving the total dose as one injection, not splitting into multiple smaller doses. These “big” doses of benzos do NOT lead to higher rates of intubation. Pts with inadequately (ie. under-dosed) treated status are at much greater risk of needing intubation
– Urgent therapy is given at the same time or right after a benzo: levetiracetam 60 mg/kg (max 4500 mg)/ valproic acid 40 mg/kg / phenytoin or fosphenytoin 20 mg/kg
– Given the results of ESETT, all three agents work equally well. Consider using levetiracetam for most patients given ability to be given as an IV push at the bedside and its lack of side effects
– If patients are still seizing, they are in refractory status: they will need intubation (consider RSI using midazolam, propofol, or ketamine) along with high-doses of continuous infusions of midazolam, propofol, or ketamine, among others. Pts will need continuous EEG monitoring and may be on numerous anti-epileptic drugs, especially if they develop super-refractory status (seizing for > 24 hours)