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
History of Present Illness
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.
Cholecystectomy 15 years ago
Appendectomy 21 years ago
Left-knee repair 5 years ago
He lives at home with his wife and two children, and works as a city bus driver.
He smokes ½ ppd of cigarettes; he drinks wine socially and denies any illicit drug use.
Lisinopril 20 mg PO daily
Simvastatin 20 mg PO at bedtime
Phenytoin ER 300 mg PO at bedtime
Docusate 100 mg PO twice daily
Acetaminophen 500 mg/hydrocodone 5 mg tablet PO every 4 h as needed for pain or HA
Deferred; patient is now unresponsive
Slightly overweight, middle-aged male with continuous convulsions of the extremities
BP 173/98 mm Hg, P 112, RR 20, T 38.0°C
Sweaty skin and scalp; (−) rashes or lesions