EPILEPSY MANAGEMENT-AUSTRALIA

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 lorazepam or diazepam iv

PNEUMONIA INFECTIOUS AGENTS

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 <200 CD4 cells not on prophylaxis.
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 anthracis, Yersinia pestis, and Francisella tularensis Bioterrorism

ANDROGEN DEFICIENCY IN MALE

Symptoms and signs suggestive of
androgen deficiency in men

• Incomplete sexual development, eunuchoidism,
aspermia
• Reduced sexual desire (libido) and activity
• Decreased spontaneous erections
• Breast discomfort, gynecomastia
• Loss of body (axillary and pubic) hair, reduced shaving
• Very small or shrinking testes (especially < 5 mL)
• Inability to father children, low or zero sperm counts
• Height loss, low-trauma fracture, low bone mineral
density
• Reduced muscle bulk and strength
• Hot flushes, sweats

AUTOSOMAL DOMINENT CONDITIONS

Autosomal dominant inheritance is seen in:


Achondroplasia, Acute intermittent porphyria, Adult polycystic kidney disease, Ehlers-Danlos syndrome, Familial adenomatous polyposis, Gilbert's syndrome, Hereditary sensory and motor neuropathy, Hereditary spherocytosis, Huntington's disease, Hyperlipidaemia type II, Malignant hyperthermia, Marfan's syndrome, Myotonia congenita, Myotonic dystrophy, Neurofibromatosis, Osteogenesis imperfecta type 1, Noonan's syndrome, Polyposis coli, Rotor syndrome, Retinoblastoma, Tuberose sclerosis, Von Hippel-Lindau disease, von Willebrand's disease

ISOTRETINOIN IN ACNE

Features of oral isotretinoin treatment
• For patients with severe acne
• For patients unresponsive to conventional therapy
• For acne patients experiencing psychological distress
• Extremely effective, as it targets all causes of acne
• Duration of treatment and daily dose are individualised
• Low starting dose is used that may be gradually increased, as
tolerated
• Side effects are usually manageable
• Warn of mood changes and the potential risk of depression
• Warn about contraception and teratogenicity