Management of Pediatric Convulsive Status Epilepticus From the Perspective of Emergency Nurses: A Cross-sectional, Multicenter Study.

INTRODUCTION: Pediatric convulsive status epilepticus is one of the most common neurologic emergencies and should be managed by health care professionals as soon as possible based on current guidelines. This study aimed to determine the nursing approaches and management of pediatric convulsive status epilepticus from the perspective of emergency nurses in Turkey. METHODS: A cross-sectional, multicenter study was conducted with 162 emergency nurses working in emergency departments in 35 different provinces in Turkey. The data were collected via an online form. Descriptive statistical methods were used in data analysis. RESULTS: Most emergency nurses (72.2%) attempted an intravenous access immediately to administer antiseizure medications during the stabilization phase. Approximately half the emergency nurses stated that rectal diazePAM was frequently administered in the initial therapy phase and intravenous diazePAM was administered in the second therapy phase. The emergency nurses had most difficulties attempting intravenous access, determining status epilepticus types, and calming the parents. DISCUSSION: As health care professionals and important members of the health team, emergency nurses have the responsibility to manage pediatric convulsive status epilepticus in the fastest and the most appropriate way based on current practice guidelines in emergency departments. When intravenous access is not available, nonintravenous benzodiazepines should be considered in the first-line treatment of pediatric convulsive status epilepticus, followed by immediate intravenous access.

Predictive value of the bispectral index for burst suppression on diagnostic electroencephalogram during drug-induced coma.

STUDY PURPOSE: To determine correlation and predictive value between data obtained with the bispectral index (BIS) and diagnostic electroencephalogram (EEG) in determining degree of burst suppression during drug-induced coma. This study seeks to answer the question: "To what degree can EEG suppression and burst count as measured by diagnostic EEG during drug-induced coma be predicted from data obtained from the BIS such as BIS value, suppression ratio (SR), and burst count?" BACKGROUND/SIGNIFICANCE: During drug-induced coma, cortical EEG is the gold standard for real-time monitoring and drug titration. Diagnostic EEG is, from setup through data analysis, labor intensive, costly, and difficult to maintain uniform clinician competency. BIS monitoring is less expensive, less labor-intensive, and easier to interpret data and establish/maintain competency. Validating BIS data versus diagnostic EEG facilitates effective brain monitoring during drug-induced coma at lower cost with similar outcomes. METHOD: This is a prospective, observational cohort study. Four consecutive patients receiving drug-induced coma/EEG monitoring were enrolled. BIS was initiated after informed consent. Variables recorded per minute included presence or absence of EEG burst suppression, burst count, BIS value over time, burst count, and SR. Pearson's product-moment and Spearman rank coefficient for BIS value and SR versus burst count were performed. Regression analysis was utilized to plot BIS values versus bursts/minute on EEG as well as SR versus burst count on EEG. EEG/BIS data were collected from digital data files and transcribed onto data sheets for corresponding time indices. RESULTS: Four patients yielded 1,972 data sets over 33 hours of EEG/BIS monitoring. Regression coefficient of 0.6673 shows robust predictive value between EEG burst count and BIS SR. Spearman rank coefficient of -0.8727 indicates strong inverse correlation between EEG burst count and BIS SR. Pearson's correlation coefficient between EEG versus BIS burst count was .8256 indicating strong positive correlation. Spearman's rank coefficient of 0.8810 and Pearson's correlation coefficient of .6819 showed strong correlation between BIS value versus EEG burst count. Number of patients (4) limits available statistics and ability to generalize results. Graphs and statistics show strong correlation/predictive value for BIS parameters to EEG suppression. CONCLUSIONS: This study is the first to measure correlation and predictive value between BIS monitoring and diagnostic EEG for degree of EEG suppression and burst count in the adult population. Available statistic tests and graphing of variables from BIS and diagnostic EEG show strong correlation and predictive value between both monitoring technologies during drug-induced coma. These support using BIS value, SR, and burst count to predict degree of EEG suppression in real time for titrating metabolic suppression therapy.

Benzodiazepine overtreatment in status epilepticus is related to higher need of intubation and longer hospitalization.

Benzodiazepine (BDZ), a widely recognized first-line status epilepticus (SE) treatment, may lead to respiratory depression. This cohort study investigates the effect of BDZ doses in SE patients in terms of morbidity and mortality. It considers incident SE episodes from a prospective registry (2009-2012), comparing patients receiving standard BDZ dose to those receiving exceeding doses (>30% above recommended dose), in terms of likelihood to receive intubation, morbidity, and mortality. Duration of hospitalization was assessed for subjects needing intubation for airways protection (not for refractory SE treatment) versus matched subjects not admitted to the intensive care unit (ICU). We identified 29 subjects receiving "excessive" and 173 "standard" BDZ dose; 45% of the overtreated patients were intubated for airways protection, but only 8% in the standard-dose group (p < 0.001). However, both groups presented similar clinical outcomes: 50% returned to baseline, 40% acquired a new handicap, and 10% died. Orotracheal intubation due to airways protection was associated with significantly longer hospitalization (mean 2 weeks vs. 1 week, p = 0.008). In conclusion, although administration of excessive BDZ doses in SE treatment does not seem to influence outcome, it is related to higher respiratory depression risk and longer hospitalization, potentially exposing patients to additional complications and costs.

Hemolytic uremic syndrome: a case review.

Hemolytic uremic syndrome is a complex disease that impacts multiple body systems. Knowledge gained from cases has increased understanding of etiologic factors, presenting symptoms, diagnostic laboratory findings, and the disease process. In rare cases, severe neurological symptoms are evident. This 20-year-old woman presented with bloody diarrhea that progressed quickly to respiratory distress requiring intubation and to the development of status epilepticus, controlled only by a barbiturate coma. Ongoing nursing care in the critical care unit was vital in preventing complications and promoting a positive outcome.

Nursing patients with epilepsy in secondary care settings.

This article gives a brief overview of epilepsy and how a diagnosis is made. It highlights the importance of good observation and communication in its ongoing management. Long-term management of the condition and the acute management of seizures are considered. The article emphasises the effect on the individual, family and carers, identifies the key legislation and highlights the crucial role of secondary care nurses.

Clinical skills: practical guide for managing adults with epilepsy.

This article concentrates on the practical management of those with seizures by general nurses. It focuses on the role of the hospital nurse in secondary care and the practice nurse in primary care. Both need to be conversant and practically competent to deal with the first-aid management of a seizure. They also need to know when medical assistance is required and how to act in an emergency. Epilepsy is a chronic long-term condition in adults and the main function of the nurse is advisory and educational. It is to act as a facilitator, and to assist adults to self-manage their epilepsy. Where the nurse is unable to provide this advice, appropriate referrals or contacts should be given.

Status epilepticus on the intensive care unit.

Status epilepticus occurs on the intensive care unit, either because the patient has been transferred with refractory status epilepticus or as an incidental finding. Management of refractory status epilepticus on the intensive care unit is necessary for adequate treatment of the physiological compromise that occurs in convulsive status epilepticus. In addition, anaesthesia is sometimes necessary for the treatment of status epilepticus, and provided that the potential benefit of anaesthesia offsets the associated morbidity, then such an approach is warranted. In certain instances of nonconvulsive status epilepticus, especially in the elderly, the risks of anaesthesia outweigh the benefits of such aggressive treatment, and thus some caution must be exercised. Status epilepticus is also under-recognised as a cause of persistent coma on the intensive care unit, though the gain from aggressive treatment in this situation is unknown. In most instances, status epilepticus in coma carries such a poor prognosis that aggressive treatment is probably justified. Myoclonic status epilepticus also occurs on the intensive care unit, usually following cardiorespiratory arrest; this does not necessarily represent an agonal event especially if the initial insult was hypoxia related.

Treatment of out-of-hospital status epilepticus with diazepam rectal gel.

Intravenous access cannot always be promptly obtained when treating status epilepticus outside the hospital. We compared the efficacy and safety of diazepam rectal gel to IV lorazepam in our long-term care facility for adults with developmental disabilities. Diazepam rectal gel was given more quickly and reliably, reducing total seizure time, potential neuronal injury and other complications. A treatment protocol for treating status epilepticus with diazepam rectal gel is given.

Estado epiléptico / Been epileptic

Se define como una actividad convulsiva continua durante 30 minutos o intermitente en un periodo de 30 minutos sin que el paciente recobre el conocimiento.(au)

Evaluation of an algorithm for treatment of status epilepticus in adult patients undergoing video/EEG monitoring.

Convulsive or generalized tonic clonic status epilepticus (SE) is a neurological emergency that can lead to transient or permanent brain damage or even death. An algorithm was designed to aid nursing and medical staff members in decision making about the type of SE and pharmacological intervention needed to stop prolonged or repetitive seizures. Fifteen registered nurses at a northern New England medical center's epilepsy unit participated in educational sessions on classification of seizures and status epilepticus prior to use of the algorithm. A pretest-posttest design with an investigator-developed tool was used to measure SE knowledge before and after educational intervention. There was a significant improvement in scores on the posttest of the classification of status epilepticus (Z = -2.93, p = .003). Twenty-nine medical records of patients who had experienced SE between February 1992 and December 1997 were reviewed. Nineteen patients experienced SE before the algorithm was implemented, and 10 patients experienced SE after the algorithm was implemented. A total of 16 patients experienced generalized convulsive SE with 12 episodes occurring before and 4 episodes after algorithm implementation. The mean time taken to stop the episode of SE after pharmacologic treatment began was compared in both groups using a t-test. The mean difference between the groups was 235 minutes (t = 2.57, p = .026). The findings of this project demonstrate that combining a treatment algorithm with education of staff members on its use has benefits in the practice setting of an inpatient comprehensive epilepsy program. Episodes of SE are more accurately classified and successful treatment of the episodes occurs earlier.

An algorithm for diagnosis and treatment of status epilepticus in adults.

Convulsive or generalized tonic-clonic status epilepticus (SE) is a neurological emergency that can lead to transient or permanent brain damage or even death. A conceptual model was developed to assist nurses and other medical professionals to differentiate between convulsive and nonconvulsive SE. An algorithm was then designed to aid nursing and medical staff in decision making about the type of SE and pharmacological intervention needed to stop prolonged or repetitive seizures occurring in patients undergoing video electroencephalogram (EEG) monitoring. A treatment algorithm for diagnosing and treating SE has clinical benefits in the practice setting of an inpatient comprehensive epilepsy program. Episodes of SE are more accurately classified and faster successful treatment of the episode occurs.

Fluoxetine, electroconvulsive therapy, and prolonged seizures. Nursing assessment leads to patient safety.

The study sought to find whether the discontinuation of fluoxetine (Prozac) 14 days prior to electroconvulsive therapy (ECT) results in positive patient outcome through improved safety and if the administration of Prozac in close proximity to ECT results in prolonged seizures. Patients who had ECT with 14 days' clearance of Prozac had no prolonged seizure activity. The awareness of possible complications resulting from Prozac and ECT soon became evident among the staff, and every effort was made to communicate this. Prozac has been promoted as being safer than tricyclic antidepressants because of its low cardiac toxicity and relative safety in overdoses.