tonicclonic Status Epilepticus in Children广义强直阵挛性癫痫持续状态的儿童ppt课件.pptVIP

Generalized, Tonic-Clonic Status Epilepticus in Children;Objectives;Status epilepticus (SE) presents in a multitude of forms, dependent on etiology and patient age (myoclonic, tonic, subtle, tonic-clonic, absence, complex partial etc.) Generalized, tonic-clonic SE (GCSE) is the most common form of SE The following presentation refers to generalized, tonic-clonic SE ;Definition;Why 30 minutes ?;More practical: Mechanistic definition;The longer SE persists, the lower is the likelihood of spontaneous cessation the harder it is to control the higher is the risk of morbidity and mortality Bleck TP. Epilepsia 1999;40(1):S64-6 The Status Epilepticus Working Party. Arch Dis Child 2000;83(5):415-9.;Typical seizure duration;Revised Definition;Causes;Causes;Epidemiology;Pathophysiology;Drugs which can cause seizures;Mortality;Mortality;Prolonged seizures;Respiratory;Hypoxia;Neurogenic Pulmonary Edema;Acidosis;Hemodynamics;Cerebral blood flow - Cerebral O2 requirement;Glucose;Hyperpyrexia;;Oxygen, oral airway. Suction. Avoid hypoxia! Consider bag-valve mask ventilation. Consider intubation IV/IO access. Treat hypotension, but NOT hypertension;Treatment;Initial investigations;Initial investigations;Treatment;Treatment;Anticonvulsants;Anticonvulsants - Rapid acting;Benzodiazepines;Benzodiazepine - Rectal;Benzodiazepine - Intramuscular;Anticonvulsants - Long acting;If in doubt, measure free phenytoin!;Anticonvulsants - Long acting;Recommendations For 1° Therapy;Alternative 2° Drugs;Initial choice of long acting anticonvulsants in SE;If SE persists;Non - convulsive status epilepticus;Non - convulsive SE ?;Non - convulsive SE ?;Non - convulsive SE ?;Suggested Reading