BUMC Basics.pdf - Anesthesia Home

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SEIZURES
Can use BZD ativan IV or valium rectally if no access (0.1
mg/kg max IV if needed) to stop seizure, most seizures will be
self limiting and brief not requiring treatment. If patient having
frequent convulsive seizures and not returning to baseline
between events or if two or more events last longer than 30
minutes and patient not awakening between, see status
epilepticus below.
Etiology: ABCDE
• Alcohol withdrawal, illicit drugs
• Brain tumor or trauma
• CVA
• Degenerative disorders of the CNS (Alzheimers)
• Electrolytes (Na) and other metabolic (uremia, liver
failure, hypoglycemic), Epilepsy
Diagnostic studies — CBC, CMP, Utox, med levels,
ETOH level, EEG, MRI or CT head, LP
Treatment:
1. Treat underlying condition
2. Anti-epileptic drugs (AED) for patients with underlying
structural disorder or idiopathic seizure plus: a) status
on presentation, b) focal neuro exam, c) Todd’s
paralysis, or d) abnormal EEG
3. Introduce slowly and monitor closely
4. Check levels on medication until therapeutic
5. May consider withdrawing tx if seizure free for a
defined interval (ex: 1 year) and normal EEG in select
patients
6. In TX: Need to be seizure free x 6 months to drive
STATUS EPILEPTICUS
Definition — One continuous seizure lasting >5-10min or
two or more discrete seizures between which there is
incomplete recovery back to baseline
Stat labs — DFS, Na, Ca, serum and urine tox screen, AED
levels