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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Explain the urgency of diagnosis and treatment of status epilepticus

  • Recognize the signs and symptoms of status epilepticus

  • Identify the treatment options available for termination of status epilepticus

  • Formulate an initial treatment strategy for a patient in generalized convulsive status epilepticus

  • Recommend monitoring parameters for a patient in status epilepticus

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PATIENT PRESENTATION

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History of Present Illness

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James Lee is a 48-year-old African American male who was admitted to the hospital 2 days ago for treatment of a subdural hematoma that he incurred after falling down the steps in front of his home and hitting his head. He had surgical evacuation of the hematoma on the day of admission and is recovering in the surgical step-down unit. He had been loaded with phenytoin postoperatively to prevent seizures. The nurse went into his room to take his vital signs and found him unarousable with all his extremities shaking. He was seen talking on the phone 10 minutes before.

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Past Medical History

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HTN

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Type 2 DM

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Dyslipidemia

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Asthma

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Past Surgical History

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Cholecystectomy 15 years ago

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Appendectomy 21 years ago

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Left-knee repair 5 years ago

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Family History

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HTN in father

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DM in mother

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Social History

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He lives at home with his wife and two children, and works as a city bus driver.

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He smokes ½ ppd of cigarettes; he drinks wine socially and denies any illicit drug use.

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Allergies/Intolerances

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Sulfa (hives)

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Current Medications

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Lisinopril 20 mg PO daily

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Glyburide 5 mg PO daily

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HCTZ 25 mg PO daily

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Simvastatin 20 mg PO at bedtime

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Phenytoin ER 300 mg PO at bedtime

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Docusate 100 mg PO twice daily

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Acetaminophen 500 mg/hydrocodone 5 mg tablet PO every 4 h as needed for pain or HA

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Review of Systems

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Deferred; patient is now unresponsive

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Physical Examination

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General
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Slightly overweight, middle-aged male with continuous convulsions of the extremities

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Vital Signs
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BP 173/98 mm Hg, P 112, RR 20, T 38.0°C

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Weight 220 lb (100 kg)

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Height 62 in. (157 cm)

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Unable to evaluate pain

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Skin
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Sweaty skin and scalp; (−) rashes or lesions

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HEENT
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Persistent upward gaze

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Cardiovascular
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