IBCC Episode 76 - Status Epilepticus

The Internet Book of Critical Care Podcast

Adam Thomas

Foam, Medicine, Health & Fitness, Science, Criticalcare, Medicaleducation

5 • 714 Ratings

🗓️ 10 February 2020

⏱️ 43 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode we cover that rapidly progressive, big stakes entity that is Status epilepticus - the unrelenting seizure. Definition, Big Benzoes and where to go after that first line. Come listen for all things Keppra, Propofol and Ketamine.

Transcript

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0:00.0	All right, so welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas
0:08.8	and we're going to talk about status epilepticus. Ah, this one's fun. This is one of those things where
0:13.1	you feel like you can do something when all heck breaks loose. Hey, Josh? Yeah, no, I love status
0:18.5	epileptic. Most of these patients can do fairly well and it's very
0:21.1	treatable and aggressive approaches often work. So today, we're going to cover why the first five to
0:26.2	20 minutes of these resuscitations are really, really important because you've got to get on
0:29.8	this right away if it doesn't settle down on its own. So of course, we'll give you a definition of
0:34.0	status epilepticus and it's all over the map and it's finally been focused down
0:38.3	in the last couple years. We'll talk about the investigation, things not to miss and of course
0:42.2	treatment, treatment, treatment. So getting straight into it, Josh, the definition of status
0:47.1	epilepticus depends on who you talk to and what historical documents you go over. So give me a
0:53.1	straightforward and clinically useful definition.
0:56.5	Historically, this has sometimes been defined as a seizure, which is ongoing for over 30 minutes.
1:00.7	And I think that has uniformly been changed at this point to any seizure lasting over five minutes.
1:05.6	And the concept there is that a self-terminating seizure will almost always stop within five minutes.
1:09.8	So if it's going over five minutes, you need to do something about it. So that's one way that someone can qualify for
1:14.3	status epileptic. The other way is multiple seizures without any normal retention of consciousness
1:18.8	in between. And then we'll go over this throughout the podcast, but we talk about generalized
1:22.9	seizures and partial seizures. And we're getting rid of that old school diagnosis of a simple focal seizure or a
1:29.3	complex focal. What is the difference here to make it simple between a generalized and a partial
1:34.4	seizure? Yeah. So most of what we're talking about in this podcast will be generalized convulsive
1:38.6	status epilepticus. And this needs to be differentiated from a phenomenon called epilepsy of
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