CASE 3 EMERGENSI MEDICVivian Otha Vashti405090216

Etiology

Risk factor

History of epilepsyHistory of head trauma plus unconsciousnessHistory of Meningitis History of EnchephalitisHistory of febrile seizure

I. Idiopatic (primer) Tidak diketahui penyebabnya Merupakan jenis epilepsi terbanyak Sering kali menunjukkan predisposisi

genetik

Head injury Cerebral Tumor Metabolic dissorder Infection of SSP Congenital Anomali Drugs and Alcohol Cerebrovasculer dissease Degeneratif dissease

II. Simptomatic (sekunder)

Criteria of Seizures

Neonatal seizure Baby (0-28 day)

Febris seizure Seizure >38 c ͦ (extracranial process)

Long seizure Seizure >15 minute

Recurrent seizure More than 3x/ >24 hour

Status epilepticus

Seizure > 30 minute without consiousness

Epileptic Seizures without provocation > 2x

http://www.easyhealth.org.uk/cmsimages/Seizure-types-1_1255.gif

Mioclonic

Algorithm

DOSE and SIDE EFFECT

STATUS EPILEPTICUSIs continue seizure activity lasting >30 minute or two or more sequential seizures without full recovery of conciousness.

Etiology Idiopatic Seizures Infection of SSP Inadequat drugs Head Injury Hipoxia Metabolic dissorder Toxic Etanol Tumor Vaskuler lession Progressif Neurologic Disorder

Clinical Manifestation

Tonic/clonic activity (general persisten) Tonic and/clonic activity (focal persisten) unconciousness

ManagementGoals : to prevent or minimize the

morbidity and mortality resulting from SE.

Divided into 3 phases : Emergency stabilization Anticonvulsant therapy Diagnostic work-up

I. Emergency Stabilization1. Prevent secondary hipoxia-ischemic brain injury2. Establish and adequat airway, ensure adequat

oxigenation and ventilation3. Establish venous or IO access and ensure effective

circulating blood volume and perfusion pressure4. Obtain blood for glucose determination5. Control fever6. Pass a NGT , aspirate for toxicology7. Assess cardiorespiratory status after

anticonvulsants

DIAZEPAM (iv) atau DIAZEPAM (rektal)0,3 – 0,5 mg/kg IV (MAKS. 20 mg) 5 mg (BB<10kg)

(MIDAZOLAM) 10 mg (BB>10 kg)

Seizures don’t stoprepeat 5 minute later : DIAZEPAM iv/rektal

Seizure STOP STOP medication Seizures don’t stop

FENITOIN ( 15 – 20 mg/kg IV)

Seizures dont’ stop (>30 minute) Stop

FENOBARBITAL 12 hrs after initial

(10-20 mg/kg im) FENITOIN ( 5 – 7 mg/kg/hr )

Seizures dont’ stop : PICU Seizure STOP

MIDAZOLAM 12 hrs after initial dose

FENOBARBITAL 3 – 4 mg/kg IMFENITOIN 5 – 7 mg/kg IV)

ANTICONVULSANT THERAPY

10 – 15 minute

Diazepam, Lorazepam, Midazolam (rapid onset short duration of action)Side effect : Resp. Depression, sedation, hypotension

Phenytoin 18 mg/kg ivSide effect : bradycardia, less sedation, doesn’t cause resp. depression and hypotension

Phenobarbital 15 – 20 mg/kg iv (DOC for neonatal SE)Side effect : Resp. Depression, sedation, hypotension

Assessment

Laboratory : Normal (except : toxic) Imaging : Normal (except : abN struktural) EEG : abN