Status Epilepticus

exp date isn't null, but text field is

Note: this is a medical emergency, not a mental health emergency, but often in Malawi it is brought to mental health services. While basic seizure management can be done in mental health settings, the goal should be to stabilize the patient and refer to medical colleagues.

Mental health practitioners should NOT be managing children with seizures – refer to Paediatrics as an emergency.

Definition

  • Continuous seizure activity or seizures without recovery of consciousness for > 30 minutes. However, treatment should be given for any seizure lasting longer than 5 minutes.
  • Always an emergency, mortality is high. Best managed in a hospital.

Treatment

  • Clear airway, insert IV-line (if available), position patient in the recovery position (see below).
  • Do not insert any object between the teeth.
  • Unavailable drug? - just move down to next stage.

Stage 1

Convulsion >5 mins

  • Check blood sugar. Give glucose, if suspicious of hypoglycaemia. Give Thiamine 100mg IV or IM once daily before giving glucose if patient suffers from alcoholism. Continue for 3 days.

No IV access, give:

  • Diazepam rectally 10mg

OR

  • Midazolam bucally/intranasally 10mg adult, if available

IV access, give:

  • Diazepam 10mg IV

OR

  • Lorazepam 4mg IV, if available

Stage 2

Convulsions continue after 10 mins

  • Give second dose of medication in Stage 1

Stage 3

Convulsions continuing

  • Refer urgently to medical setting
  • Recheck Airway Breathing Circulation (ABC), monitor need for intubation/ventilation if available
  • If patient improves, start anti-epileptic treatment and continue until cause of status epilepticus is treated.
  • Monitor continuously for respiratory depression when administering Diazepam, especially if IV.

 

RECOVERY POSITION