Critical Matters Seizures In The ICU
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Jun 12, 2019 Dr. Thomas Bleck, a seasoned neurointensivist and professor at Rush University Medical Center, dives deep into the management of seizures in the ICU. He shares insights on the best practices for treating status epilepticus, emphasizing the importance of prompt intervention and proper medication dosing. Dr. Bleck explains how to differentiate between epileptic and non-epileptic seizures using EEG and discusses the significance of continuous EEG monitoring. He also highlights the prognostic implications of seizures post-cardiac arrest and the advancement of neurocritical care.
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Immediate Steps For A Seizing Patient
- Observe and protect the patient first because most seizures stop spontaneously within minutes.
- If seizures persist, give benzodiazepines (lorazepam 0.1 mg/kg IV or midazolam 10–20 mg IM) promptly rather than immediate intubation.
Avoid Underdosing Levetiracetam
- Use adequate loading doses for second-line anti-seizure drugs and avoid underdosing levetiracetam.
- Give levetiracetam 60 mg/kg (or appropriate high IV load) rather than small empiric doses of 500–1000 mg.
Choose And Load Second-Line Agents Properly
- After benzodiazepines fail, choose an adequate second-line agent (phenytoin/fosphenytoin, valproate, levetiracetam) at proper loading doses.
- Consider lacosamide at 10–15 mg/kg if appropriate, recognizing evidence is evolving.
