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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When To Use General Anesthesia
- If second-line drugs fail, escalate to general anesthesia using propofol or high-dose midazolam to suppress status epilepticus.
- Choose the anesthetic based on who will monitor the EEG and be prepared to titrate infusion rates aggressively.
Timing Defines Status And Risk
- Define status epilepticus operationally: treat seizures after five minutes to improve chances of control.
- Recognize brain-damaging effects rise around 30 minutes, so aim for control within 20–30 minutes.
Be Judicious With Intubation Choices
- Don't intubate reflexively; try benzodiazepine and second-line loading if the airway is protected.
- If intubation is required, avoid succinylcholine with unknown neuromuscular disease and consider reversing paralytics to assess seizures.
