CASE 3 EMERGENSI MEDIC

Vivian Otha Vashti 405090216

Etiology

Risk factor
History of epilepsy History of head trauma plus unconsciousness History of Meningitis History of Enchephalitis History of febrile seizure

I. Idiopatic (primer)

Tidak diketahui penyebabnya Merupakan jenis epilepsi terbanyak Sering kali menunjukkan predisposisi genetik

II. Simptomatic (sekunder)

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

Criteria of Seizures
Neonatal seizure Febris seizure
Baby (0-28 day) Seizure >38 c (extracranial process)

Long seizure
Recurrent seizure Status epilepticus Epileptic

Seizure >15 minute More than 3x/ >24 hour

Seizure > 30 minute without consiousness

Seizures without provocation > 2x

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

Mioclonic

Algorithm

DOSE and SIDE EFFECT

STATUS EPILEPTICUS
Is 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

Management
Goals : to prevent or minimize the morbidity and mortality resulting from SE.

Divided into 3 phases :

Emergency

stabilization Anticonvulsant therapy Diagnostic work-up

I. Emergency Stabilization
Prevent secondary hipoxia-ischemic brain injury 2. Establish and adequat airway, ensure adequat oxigenation and ventilation 3. Establish venous or IO access and ensure effective circulating blood volume and perfusion pressure 4. Obtain blood for glucose determination 5. Control fever 6. Pass a NGT , aspirate for toxicology 7. Assess cardiorespiratory status after anticonvulsants
1.

ANTICONVULSANT THERAPY

DIAZEPAM (iv)
0,3 0,5 mg/kg IV (MAKS. 20 mg)

atau
(MIDAZOLAM)

DIAZEPAM (rektal)
5 mg (BB<10kg) 10 mg (BB>10 kg)

Seizures dont stop

repeat 5 minute later : DIAZEPAM iv/rektal
10 15 minute

Seizure STOP STOP medication

Seizures dont stop

FENITOIN ( 15 20 mg/kg IV)

Seizures dont stop (>30 minute) Stop 12 hrs after initial FENITOIN ( 5 7 mg/kg/hr )

FENOBARBITAL
(10-20 mg/kg im)

Seizures dont stop : PICU

Seizure STOP

MIDAZOLAM

12 hrs after initial dose

FENOBARBITAL 3 4 mg/kg IM

FENITOIN 5 7 mg/kg IV)

Diazepam, Lorazepam, Midazolam (rapid onset short duration of action)

Side effect : Resp. Depression, sedation, hypotension

Phenytoin 18 mg/kg iv
Side effect : bradycardia, less sedation, doesnt 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