Management of Status Epilepticus
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A 34-year-old male patient presented to casualty with tonic-clonic seizures. He was treated with two doses of 0.1 mg/kg of intravenous (IV) lorazepam with in 5 min apart with oxygen supplementation and airway support, in addition, Phenytoin 20 mg/kg IV was administered over 30 min. On examination, the patient was found unresponsive and continued to have seizures. The patient was intubated for airway protection, and IV Levetiracetam 30 mg/kg bolus was administered. The patient was put on mechanical ventilation, and he continued to have seizures. Intravenous anesthetic midazolam 0.2 mg/kg bolus was given followed by 0.2 mg/kg/h, titrated up to 0.6 mg/kg. Electroencephalogram (EEG) monitoring instituted to monitor for seizure activity. Laboratory workup was with in normal limit, and computed tomography (CT) brain did not reveal any intracranial bleed/mass or features of raised intracranial pressure. The patient continued to have clinical seizures once in every 40 min, for which a thiopental sodium bolus of 4 mg/Kg followed by infusion at 5 mg/kg/h was initiated. The patient continued to have focal motor seizures and EEG showed a generalization of the seizure (Fig. 13.1a). Ketamine 1 mg/kg bolus followed by 2 mg/kg/h of infusion was instituted for control of seizures clinically and electroencephalographically (Fig. 13.1b).
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