What's that Seizure?
What seizure is portrayed in this video?
Generalized Tonic-clonic video
A main side effect of Phenobarbital and Pentobarbital is...
CNS depression
The provider orders 50mg of ketamine. How many mLs are you giving?
5mL
Are seizures and storming the same thing?
No
What specific safety device should be used on the bed for a patient with seizures?
Seizure pads
What seizure is portrayed in this video?
Absence seizure
You just got in report that your patient is in status epilepticus in the ED after receiving multiple rescues and getting intubated. Which drip do you anticipate the patient will be needing once they arrive to the PICU?
Versed gtt and/or ketamine drip
What are the two concentrations of midazolam that we see in the PICU? Which concentration are we most likely to use for sedation vs. seizures?
1:1 – see this most often for sedation; can also be used for seizures.
5:1 – see this occasionally (not always) when a patient is on a Versed drip for status if they are on a high dose.
What are potential triggers for neurostorming?
A. Pain
B. Repositioning
C. Noxious external stimuli
D. Suctioning
E. All of the above
E
Where do you document in EPIC when a patient has a seizure?
The “Seizure/Event” flowsheet
Your patient is having multiple seizures throughout this shift? What is this grouping called?
Clusters
What are some adverse effects to administering Ketamine?
Increased secretions, delirium, hypertension
What is the concentration of diazepam?
5:1
What is the typical rescue plan for neurostorming?
Environmental comforts: lights off, uncover patient, turn down room temperature, minimize any stimuli in the room
Acetaminophen (Tylenol)
Diazepam (valium)
Your patient is on EEG, and you believe they may be having a seizure. What do you do?
Note the time it started and how long, hit the EEG button, call your MD
Is this a seizure?
Talking through a seizure video
What three seizure medications require therapeutic drug monitoring after administration?
Phenobarbital, Valproate, Fosphenytoin
What is the 5:1 concentration of versed not compatible with that the 1:1 concentration is compatible with?
?
What are classic signs of storming?
Hypertension, tachycardia, diaphoretic, oxygen desaturations, posturing, agitation
Your patient is having a tonic-clonic seizure. They’re currently on room air. What should one of your first interventions be?
Turning them on their side
Your patient stops responding to commands and begins involuntarily lip smacking with staring. What seizure/event type would you chart in Epic?
Staring with Automatisms
Which of these medications can you not override in the pyxis? Lorazepam, diazepam, fosphenytoin, pentobarbital
You're first line seizure rescue medication is lorazepam (ativan). The order is for 1.5 mg IV push. How many mLs will you be administering.
0.75 mL
What scheduled medications do you expect your patient to be on if they have a frequent history of neurostorming?
Beta-blockers (propranolol), clonidine, gabapentin, benzodiazepines, and baclofen: can all help manage neurostorming.
What can precipitate a seizure? (Select all that apply)
A: Fever
B: loud noises
C: eating
D: sleep deprivation
A, B, D
fever, loud noises, sleep deprivation