Status Epilepticus

Template for plan of management (Status Epilepticus) Plan:
– Neurological checks q1h
Seizure, fall, aspiration precautions
– SBP goal 100-140
– CTH:
– Continous video EEG ordered
– Burst Suppression:

  1. Midazolam drip starting with 0.05mg/kg/h up to 2mg/kg/h till burst suppression is achieved
  2. Will continue burst suppression for at least 24h after last seizure (clinical or electrophysiological)
  3. Once burst suppression is completed, will taper down sedation over 24h.

– Meds:

  1. Midazolam drip (starting at 0.05 mg/kg/h, titrate up to 2 mg/kg/h)
  2. Fentanyl drip starting with 25mcg/h for analgesia while on mechanical ventilation.
  3. Continue on home AED medications (***)
  4. Propofol will be on board if further sedation is required for mechanical ventilation.

– Aspiration precautions, head of bed above 30 degrees
– Chest PT with vest q4hr
– Daily CXR while intubated
– Suctioning q1-2 hours
– Meds:
– Duonebs q4h
– Continuous cardiac telemetry
– SBP goal 100-140
– Meds:
-Labetalol 10mg IV q4h prn
– Renal function normal
– Monitor daily BMP, Mg, Phos
– Foley with temperature probe for strict I&O monitoring in critical care setting
– Avoid hypotonic fluids as this can worsen cerebral edema
– Meds:
– IVFs with NS at 75/h
– Place Dobhoff tube for medication/nutrition; Abdominal X-ray to confirm placement ordered
– Start tube feeding with Peptamen 1.5 @ 10cc/hr and titrate to goal 50cc/hr as tolerated
– Hold TF for residuals > 300
– Last BM: unknown
– Meds:
– Docusate 100 mg PO TID
– Famitidine 20mg tab bid
– FSBS q6hr while NPO/TF
– Check HgbA1c, TSH
– Meds:
– Insulin SS
– Hypoglycemia protocol
– Monitor CBC daily
– SCDs, enoxaparin 40mg daily for prophylaxis
– Meds:
– Enoxaparin 40mg q24h
Infectious Disease:
– Current access: PIVs (placed)
– Keep normothermic, aggressive fever control as this worsens neurological outcomes
– Meds:
-APAP 500mg q6h prn fever > 38.3
DVT: SCDs, enoxaparin 40mg daily
GI: famotidine, docusate
Nutrition ________________________________________________
Discharge Planning:
Patient requires ICU level of care for monitoring while on mechanical ventilation.
Patient was discussed with the neurocritical care attending who agrees with current plan of management.

Important Links:

Status Epilepticus Protocol from MGH

Guidelines for Treatment of Status Epilepticus from Neurocritical care Society

Status Epilepticus Treatment in Infants and Children from BCMJ