Here is a brief talk on managing patients with status.

The definition of Status Epilepticus is a seizure lasting more or equal to 30 minutes, or several seizures without complete resolution between seizures.

The options for inititally treating seizures is to give a choice of benzodiazepines. The choice of benzos is between diazepam, which has long been used and midazolam. Each has pros and cons. Diazepam has the advantages of being able to be given rectally if no IV access is available. The doses are different. Midazolam has the advantages of being given IM or IV, with similar bioavailability profiles. The doses are the same 0.15mg/kg. I prefer this drug. Easy to remember one dose and easy to give.

If the seizure continues, it is appropriate to give more benzodiazepine. It may also be prudent to load with phenytoin. Be aware that too rapid a load with this may cause hypotension. If the patient is already on phenytoin, the question becomes, are they taking their meds. It is appropriate to load, in children we will half load.

If the seizure ends at this point, it will be important to manage the airway, as these patients are post-ictal with significant sedation on-board. All that may be required is some jaw thrust in combination with high flow oxygen.

If the patient continues to seize, intubation is then considered. Use of thiopentone, (which is effective in stopping seizures),  for both intubation and as an infusion, works well.

BEWARE, although the tonic-clonic component of the seizure is over, the patient may still have neuronal seizure activity. This may sometimes be picked up by tachycardia, but the most reliable way to monitor is by eeg.

Electrical Burns can be a significant injury. Patients with electrical burns present infrequently to the ED. It is important to know how to approach these patients. There are different groups and approaches. There is a bimodal distribution of electrical injuries and some of the literature discusses a trimodal distribution.

The first peak is childhood electrical burns. these are usually burns of the mouth due to children chewing through an electrical cord. The next group is those that occur to those working with electricity and then those other who display risky behaviour.

The severe burn presents a challenge in terms of fluid resuscitation as the regular application of the Parkland formula will grossly underestimate the fluid requirements.

The other group that presents a challenge is that group that may not be a clear admission. The other question that is frequently asked is who do we monitor and for how long. Here is a brief lecture on this.

There is a syndrome called ‘Brugada Syndrome’. It is a syndrome that when we recognise, we can save a life.

It’s around Christmas and someone mentions Christmas Disease. What’s that?

In those patients that have a low pre-test probability of a pulmonary embolism(PE), we can rule out PE by using the ‘PERC’ rule. This is how.