In episode 132, that was part one of this two-part podcast, we discussed an approach to the patient

who presents to the ED with a presumed resolved seizure. We talked about how to differentiate

seizure from syncope, from psychogenic seizures, from TIA and migraine, some of the issues

around drug levels and loading, workup, and disposition.

Now, in this part two, we're going to dedicate the next hour to status epilepticus.

Now, if you haven't listened to part one, much of part two won't really make so much sense.

So please go back and listen to part one first.

All right, let's do this.

Here we go with episode 133, status epilepticus with Paul Koblich and Eileen Reed.

A 22-year-old, otherwise healthy female university student presents to your ED after a witness tonic chronic

seizure that started 15 minutes prior to arrival and is ongoing as she's wheeled into

your resuscitation room by paramedics. EMS reports that she was studying in the library with her

boyfriend when she suddenly fell off the chair and immediately started seizing. EMS gave two doses of five milligrams of

Madazalam IM and were unable to establish an IV. On exam, she's unresponsive and

posturing. Initial vitals show attempt of 37.9, heart rate of 130, blood pressure of 165 on 110, and an oxygen saturation of 92% on room

air. There is no obvious signs of trauma or a gravite abdomen. The ED nurse is busy

establishing an IV, and the patient is hooked up to your recess monitor. So, Dr. Koblich, what's your general approach to this patient who is now, by definition,

a status epilepticus patient?

And just remind our listeners that the old 30 minutes of seizing is old news and the new definition

is either more than five minutes of continuous

seizure activity or two or more seizures within a five minute period without a return to

baseline in between. So Dr. Colbock, this patient has had 10 milligrams of IM-Madaz. Let's assume

...