Critical Matters Seizure Management in the ICU
14 snips
Jan 18, 2024 Dr. Brandon Foreman, an expert in epilepsy and neurocritical care at the University of Cincinnati, shares invaluable insights on managing seizures in the ICU. He discusses the high prevalence of nonconvulsive seizures among critical care patients and the importance of accurate diagnosis. Dr. Foreman details essential diagnostic steps, emphasizes the need for timely treatment to prevent neuronal injury, and explores the role of continuous EEG monitoring. He also highlights the philosophical aspect of clinical care, encouraging diagnostic flexibility and humility.
AI Snips
Chapters
Books
Transcript
Episode notes
Avoid Sedation When Airway Is At Risk
- In encephalopathic patients with tenuous airway, prefer non-sedating IV antiseizure drugs (e.g., levetiracetam, valproate, lacosamide) or low-dose ketamine.
- Avoid benzodiazepines when respiratory compromise risk outweighs seizure risk.
Maintain Chronic Seizure Meds In Hospital
- Keep patients with known epilepsy on their home antiseizure drugs even when NPO by using IV equivalents or IV access.
- Avoid missed doses because lapses commonly precipitate breakthrough seizures and status epilepticus.
Status Defined By Duration And Burden
- Status epilepticus is defined by seizure duration and likelihood to stop: >5 minutes for generalized, ~10 minutes for focal.
- For non-convulsive EEG seizures, >20% seizure burden in a 30–60 minute recording meets status criteria.
