Status Epilepticus

Status Epilepticus ProtocolStep by step approach

Impression:

Status Epilepticus:

Semiology:  ***
Etiology: ***
PTA AED: ***

Plan:

Neurological:
- Neurological checks q1h
- Seizure, fall, aspiration precautions
- SBP goal 100-140
- CTH:
- Continous video EEG ordered
- Burst Suppression:
Midazolam drip starting with 0.05mg/kg/h up to 2mg/kg/h till burst suppression is achieved
Will continue burst suppression for at least 24h after last seizure (clinical or electrophysiological)
Once burst suppression is completed, will taper down sedation over 24h.
- Meds:
Midazolam drip (starting at 0.05 mg/kg/h, titrate up to 2 mg/kg/h)
Propofol at *** mcg/kg/h
Continue on home AED medications (***)
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Respiratory:
- On mechanical ventilation, mode ***
- Daily CXR while intubated
- Suctioning q1-2 hours
- Meds:
- Duonebs q4h
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Cardiology:
- Continuous cardiac telemetry
- SBP goal 100-140
- Meds:
Labetalol 10mg IV q4h prn
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Renal:
- Renal function normal
- Monitor daily BMP, Mg, Phos
- Foley with temperature probe for strict I&O monitoring in critical care setting
- Avoid hypotonic fluids as this can worsen cerebral edema
- Meds:
IVFs with NS at 75/h
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Gastrointestinal:
- NPO
- Place Dobhoff tube for medication/nutrition; Abdominal X-ray to confirm placement ordered
- Start tube feeding with *** @ 10cc/hr and titrate to goal 50cc/hr as tolerated
- Hold TF for residuals > 300
- Last BM: unknown
- Meds:
Docusate 100 mg PO TID
Pantoprazole 40mg tab
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Endocrinology:
- FSBS q6hr while NPO/TF
- Check HgbA1c, TSH
- Meds:
Insulin SS
Hypoglycemia protocol
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Hematology:
- Monitor CBC daily
- SCDs, enoxaparin 40mg daily for prophylaxis
- Meds:
- Enoxaparin 40mg q24h
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Infectious Disease:

- Current access: PIVs (placed)
- Keep normothermic, aggressive fever control as this worsens neurological outcomes
- Meds:
-APAP 500mg q6h prn fever > 38.3
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Prophylaxis:

DVT: SCDs, enoxaparin 40mg daily
GI: pantoprazole, docusate
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Consults:
Nutrition
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Discharge Planning:

Patient requires ICU level of care for monitoring while on mechanical ventilation.
Patient was discussed with the neurocritical care attending who agrees with current plan of management.