What's the initial step of management in Status Epilepticus! - USMLE Forums
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  #1  
Old 07-16-2012
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ER What's the initial step of management in Status Epilepticus!

What will be the initial step in status epilepticus ? will it be to protect airway or to give IV lorazepam ?

In my view, patient is actively seizing so how can we protect airway ?


Secondly, in the management protocol...after ABC it is mentioned to give D50 and thiamine. That means we give them before lorazepam !!! sounds pretty strange to me. answering next step not lorazepam but Dextrose...

What is rationale behind ? to prevent wernicke ...??
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Old 07-16-2012
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Quote:
Originally Posted by tyagee View Post
What will be the initial step in status epilepticus ? will it be to protect airway or to give IV lorazepam ?

In my view, patient is actively seizing so how can we protect airway ?


Secondly, in the management protocol...after ABC it is mentioned to give D50 and thiamine. That means we give them before lorazepam !!! sounds pretty strange to me. answering next step not lorazepam but Dextrose...

What is rationale behind ? to prevent wernicke ...??
As far as my understanding goes....
if the pt is actively seizing and cyanotic.....maintain airway
then start with the status epi protocol.....i.e lorazepam phenytoin and in the end if its still nt working propofol/anesthesia
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Old 07-16-2012
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Protect airway first, even in active seizures, pt is turned to left lateral position ( forgot the exact name of this position - can be found in emergency medicine handbook) to avoid aspirating anything. Airway should also be inserted soon after the fit, to avoid further airway compromise and tongue bite.

Secondly, in the management protocol...after ABC it is mentioned to give D50 and thiamine. That means we give them before lorazepam !!! sounds pretty strange to me. answering next step not lorazepam but Dextrose...

CAN BE GIVEN IN ALCOHOLICS, DONT THINK IT MAKES SENSE IN OTHER PATIENTS.
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Old 07-17-2012
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can u plz mention the source?? cuz i hvnt read it anywhere :O
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Old 07-17-2012
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Airway is ALWAYS the first step in emergency situations (i.e. conservative airway maneuvers, bag/mask, etc.).

Breathing is ALWAYS the second step (i.e. make sure that chest is rising and that air is going in and out, pulse ox is reasonable, etc; if something is wrong, change your airway technique).

Circulation is ALWAYS the third step (i.e. insert two large-bore IV needles, check pulse, start fluids; if PEA or arrhythmia, start appropriate protocol).


Your patient won't die from status epilepticus, but they will die from airway collapse. You can give them a benzo after you make sure that they're not about to die.
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Old 07-17-2012
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Quote:
Originally Posted by jiyamirza87 View Post
can u plz mention the source?? cuz i hvnt read it anywhere :O
Sorry - i meant the recovery position, and its after the fits.
Recovery position images can be searched on google.
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