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Clinical Decisions in Emergency Medicine Ponte Vedra, FL June 22-23, 2007

Optimizing Seizure and SE Patient Management: Seizure Therapies Workshop and Clinical Policy Review. Clinical Decisions in Emergency Medicine Ponte Vedra, FL June 22-23, 2007. Patient EMS Data. 50?? yo male John Doe Generalized tonic-clonic seizure Chicago Fire Department

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Clinical Decisions in Emergency Medicine Ponte Vedra, FL June 22-23, 2007

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  1. Optimizing Seizure and SE Patient Management:Seizure Therapies Workshop and Clinical Policy Review

  2. Clinical Decisions in Emergency MedicinePonte Vedra, FLJune 22-23, 2007

  3. Patient EMS Data • 50?? yo male John Doe • Generalized tonic-clonic seizure • Chicago Fire Department • Diazepam 5 mg IM, 15 mg IV • Seizure continuous for 15 minutes + • EMS to ED

  4. Patient Clinical History • Unknown meds • Unknown medical history • Hx Needs surgery next month ?? • EtOH ?? • Does not appear to be homeless • Accucheck 119

  5. ED Presentation • Facial and shoulder twitching R • Pt with gurgling BS • Nasopharyngeal airway • No evidence of trauma or toxicity • IV access in neck • Seizure persists x minutes

  6. ED Patient Outcome

  7. ED Patient Management • Lorazepam 2 mg IVP x 5 over 10 minutes • Persistent facial and R shoulder activity • AMS: generalized seizure continues • Fosphenytoin 1 gram PE over 10 min x2 • Seizure ended, pt remained obtunded • Intubation immediately followed • Lidocaine, sux, rocuronium

  8. ED Diagnostic Evaluation • Non-contrast CT: Prior strokes, atrophy • Metabolic tests normal • Toxicology screening negative • Phenytoin level cancelled • Diagnoses: • AMS • Status Epilepticus • Respiratory Failure

  9. Family Arrives, Pt History • Pt with history refractory seizures • Hx carotid artery occlusion R • Due for carotid endarterectomy • Phenobarbital & dilantin, compliant • Prior history of SE treated at UIC • No recent illness, trauma, EtOH • No medic alert bracelet

  10. Patient Outcome • EEG in ED, within 150 minutes • Neuro consultation, no subtle SE • Admit to Neuro ICU • Repeated doses of rocuronium • Final disposition for carotid Rx

  11. Conclusions • Status epilepticus: medical emergency • Few hospitals utilize a SE protocol • SE protocol improves patient outcome • Guidelines exist that facilitate practice • New useful medications exist • SE provides a model for all AED use

  12. Questions? www.FERNE.org azinkel1@uic.edu ferne_pv_2007_seizure_sloan_cases_062207_finalcd 11/27/2014 5:35 PM Edward P. Sloan, MD, MPH

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