Seizure emergency

Kunisaki TA, Augenstein WL. 1994. Dmg-and toxin-induced seizures. Emergency Medicine Clinics Of North America 12(4) 1027-1056. 

Shafer PO. New therapies in the management of acute or cluster seizures and seizure emergencies. J Neurosci Nurs 1999 31(4) 224—30. 

Treiman DM, Waiker MC. Treatment of seizure emergencies convulsive and nonconvulsive status epilepticus. Epilepsy Res 2006 68(Suppl 1) S77-S82. 

Occasionally, status epilepticus (an emergency situation characterized by continual seizure activity with no interruptions) can occur. Diazepam (Valium) is most often the initial drug prescribed for this condition. However, because the effects of diazepam last less than 1 hour, a longer-lasting anticonvulsant, such as phenytoin or phenobarbital, also must be given to control the seizure activity. 

A number of studies have shown that adenosine inhibits neuronal firing both in vitro and in vivo and is itself released during intense neuronal activity. It can protect against PTZ seizures in rodents while the antagonist theophylline is proconvulsant. No clear picture of its role in human epilepsy has emerged. 

Instruct patients, family members, and caregivers on first aid for seizures. First aid for seizures consists primarily of keeping the patients from hurting themselves. They should be placed on the floor, if possible, and their heads cushioned. First responders to a seizure should never attempt to restrain them or force an item into their mouth. If a seizure lasts longer than 5 to 10 minutes, emergency medical assistance should be called. 

CH, a 42-year-old man, comes into the emergency department after his sister discovered him seizing at home. He has a history of hypertension, diabetes, epilepsy, and rheumatoid arthritis. His medications include hydrochlorothiazide, gly-buride, phenytoin, and aspirin. He smokes one pack per day, drinks heavily on the weekends, and has a history of cocaine use. Upon further discussion with his sister, you discover that he stopped taking his phenytoin 4 days ago due to failure to obtain a refill from his doctor. He is currently unarousable since his last seizure 10 minutes ago. 

P. falciparum malaria is a life-threatening emergency. Complications include hypoglycemia, acute renal failure, pulmonary edema, severe anemia (high parasitism), thrombocytopenia, heart failure, cerebral congestion, seizures, coma, and adult respiratory distress syndrome. 

Interestingly, many forms of partial epilepsy are characterized by a seizure-free interval lasting months to years between the occurrence of the causative insult and the emergence of epilepsy termed the latent period , this provides a valuable window of opportunity during which pharmacologic intervention might be implemented in high-risk individuals so that development of epilepsy could be prevented. 

Carbamazepine is considered an AED of first choice for newly diagnosed partial seizures and for primary GTC seizures that are not considered an emergency. 

A pediatric patient was presented to the emergency room (ER) experiencing seizures for which 150-mg Cerebyx (fosphenytoin anticonvulsant) IV was ordered. The pharmacy technician took the call for Cerebyx and delivered three 10-mL vials of Cerebyx 50-mg PE (phenytoin sodium equivalents) per mL to the ER as a floor stock transaction. A nurse misread the 50-mg PE/mL on the 10-mL container label, making the assumption that the entire vial contained 50 mg PE. The contents of all three vials were prepared for administration. Instead of 150 mg PE, the patient was administered ten times the intended dose, or 1,500 mg PE. The patient later died. The ER staff only discovered the error after the patient s blood phenytoin levels were returned from the laboratory. 

Albumin (human) Epoetin alfa contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. No cases of transmission of viral diseases or Creutzfeldt-Jakob disease have ever been identified for albumin. Anemia Not intended for CRF patients who require correction of severe anemia epoetin alfa may obviate the need for maintenance transfusions but is not a substitute for emergency transfusion. Not indicated for treatment of anemia in HIV-infected patients or cancer patients due to other factors such as iron or folate deficiencies, hemolysis, or Gl bleeding, which should be managed appropriately. Hypertension Up to 80% of patients with CRF have a history of hypertension. Do not treat patients with uncontrolled hypertension monitor blood pressure adequately before initiation of therapy. Hypertensive encephalopathy and seizures have occurred in patients with CRF treated with epoetin. 

Crack Cocaine Street Names Freebase. Mexican speedballs (crack w/ methamphetamine), roosten tornado (ovct 40 street slang terms) Use Crack is cocaine that comes in a rock crystal that can be heated and its vapors smoked. The tOTn crack ref s to the crackling sound heard when it is heated Actions CNS stimulant induces euphoria. Highly addictive Effects Acute CV or cerebrovascular emergencies (heart attack or stroke), could result in sudden death. Cocaine-related deaths are often a result of cardiac arrest or seizure followed by resp arrest (see also Cocaine)... 

You are called to the Emergency Department where a known epileptic is having recurrent grand mal seizures. A friend, who has come with him, says he knows he has not taken any of his anti-convulsant medication for at least a week, as he has been travelling and he had left the drugs behind. 

TAC (tetracaine, adrenalin [epinephrine], and cocaine) is a combination topical anesthetic frequently used in pediatric emergency departments for repair of minor lacerations. The usual mixture is tetracaine 0.5%, epinephrine 1 2,000, and cocaine 11.8%. Because of potential complications (seizures), lower concentrations of cocaine and epinephrine in a tetracaine 1% solution have been suggested (TAC III). 

Benzodiazepines are usually given orally and are well absorbed by this route. Since the benzodiazepines are weak bases, they are less ionized in the relatively alkaline environment of the small intestine, and therefore, most of their absorption takes place at this site. For emergency treatment of seizures or when used in anesthesia, the benzodiazepines also can be given parenter-ally. Diazepam and lorazepam are available for intravenous administration. 

The benzodiazepines have many clinical indications and are discussed in Chapters 25, 30, 35, and 40. As AEDs, they have their major usefulness in the treatment of absence, myoclonic, and atonic seizures and in the emergency treatment of status epilepticus. 

Lorazepam is the benzodiazepine of choice for emergency treatment of status epilepticus, serial seizures,... 

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