AMC EXAMS AUSTRALIA ,AUSTRALIAN MEDICAL EXAMS,MCQS,CLINICALS.

Treatment of status epilepticus in hospital. 1.Immediate measures Secure airway Give oxygen Assess cardiac and respiratory function Secure iv access Give lorazepam 4 mg iv or diazepam 10 mg iv Repeat after 10 mins if no response 2.In hospital Take blood for electrolytes, LFT, calcium, glucose, clotting, AED levels and storage for later analysis Measure blood gases Establish aetiology Give thiamine or 50% glucose solution if indicated Within 30 minutes In patients with established epilepsy: give usual AED orally, NG or iv 3.In patients with new-onset epilepsy or if seizures continue: fosphenytoin (18 mg/kg phenytoin equivalent), up to 150 mg/min with ECG monitoring or phenytoin 18mg/kg, 50 mg/min with ECG or phenobarbital 15 mg/kg iv, 100 mg/min Longer than ITU may be necessary minutes Anaesthetise with EEG monitoring Midazolam, phenobarbital, propofol, or thiopentone most commonly used Non-convulsive status Augment or reinstate usual AEDs Consider ...

1.Haemophilus influenza -Smokers, COPD 2.Mycoplasma --------Young, otherwise healthy patients 3.Legionella --------Epidemic infection in older smokers, particularly when located near infected water sources, such as air-conditioning systems 4.Pneumocystis jiroveci (formerly carinii) pneumonia HIV-positive persons with 5.Coxiella burnetti (Q-fever) Exposure to animals, particularly at the time they are giving birth 6.Klebsiella Alcoholics 7.Staphylococcus aureus Following viral syndromes or viral bronchitis, especially influenza 8.Coccidioidomycosis Exposure to the deserts of the American Southwest, particularly Arizona 9.Chlamydia psittaci Exposure to birds 10.Histoplasma capsulatum Exposure to bat or bird droppings, spelunking (recreational cave exploration) 11.Bordetella pertussis Cough with whoop and post-tussive vomiting 12.Francisella tularensis Hunters, or exposure to rabbits SARS, Avian injluenza Travel to Southeast Asia 13.Bacillus anthr...