status epilepticus case study
start
Status epilepticus
You are the NP working covering the night shift for a mixed neurology/neurosurgery ICU. You get a page to consult on a patient who just arrived to the ED to evaluate for admission. Patient Profile: 42 year old male 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Next
Patient Info
Vitals
Patient Info
Vitals & Clinical Data
Patient Info
Vitals
Patient Info
Vitals
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Perfect! Burst suppression can be accomplished within 24 hours, however weaning from therapeutic benzos is recommended to be a gradual 12-24 hour taper after 24-48 hours of burst suppresion, with close monitoring for return of seizure activity. Additionally, we want to ensure any maintenance AEDs (Keppra, for our patient) are therapeutic before weaning, so we anticipate our patient to spend at least a couple days in the ICU.
Patient Info
Vitals & Clinical Data
Lets dive into this! Burst suppression can be accomplished within 24 hours, however weaning from therapeutic benzos is recommended to be a gradual 12-24 hour taper after 24-48 hours of burst suppresion, with close monitoring for return of seizure activity. Additionally, we want to ensure any maintenance AEDs (Keppra, for our patient) are therapeutic before weaning, so we anticipate our patient to spend at least a couple days in the ICU.
Patient Info
Vitals & Clinical Data
Correct! We will want to begin weaning the midazolam slowly to avoid refractory seizures. Keppra is still therapeutic.
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Strong work! We want to wait 24 hours after resuming the midazolam at it's prior dose before attempting to wean again, so while we wait, we'll optimize AEDs. You decide to order valproic acid with a loading dose followed by continuous infusion. He remains hemodynamically stable with cEEG on. You leave for the day with orders placed for keppra and valproic acid levels to be drawn in 12 hours.
Patient Info
Vitals & Clinical Data
Continue
Patient Info
Vitals & Clinical Data
WEll Done!
Your patient is discharged!
Your judicious early planning for AED management after discharge was well facilitated with scheduled trough levels the AEDs until discharge. You provide a written medication reconciliation, counsel on alcohol cessation and medication management. You ensure there is a follow-up appointment with neurology in one week scheduled prior to discharge. We don't want to do any AED regimen changes during this care transition, and reiterate medication adherance.
Restart
References
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC6095773/ https://seizure.mgh.harvard.edu/wp-content/uploads/MGH_Status_Protocol_01_09_2015.pdf https://pmc.ncbi.nlm.nih.gov/articles/PMC6095773/ https://www.ncbi.nlm.nih.gov/books/NBK580620/ https://www.ncbi.nlm.nih.gov/books/NBK559112/ https://pubmed.ncbi.nlm.nih.gov/35239286/
Restart
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 1
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 88% Temp: 97.3 Blood glucose: 62 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 1
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 94% on NRB Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 88% Temp: 97.3 Blood glucose: 62 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ED Arrival
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) after intubation SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 94% on NRB Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ICU Day 1
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 88% Temp: 97.3 Blood glucose: 62 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
ICU Day 1
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 94% on NRB Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 128/78 (95) HR: 96 RR: 14 (PS/CPAP: PEEP 8, RR 8, 30% FiO2) SpO2: 98% on vent Temp: 97 Keppra level: 40 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 6
Vitals & Clinical Data
BP: 132/71 (91) HR: 87 RR: 13 SpO2: 97% on room air Temp: 97.2 CIWA: 2-3 Keppra level: 40 mg/L (therapeutic) Valproic acid level: 60 mg/L (therapeutic) Lacosamide level: 12 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 6
Vitals & Clinical Data
BP: 132/71 (91) HR: 87 RR: 13 SpO2: 97% on room air Temp: 97.2 CIWA: 2-3 Keppra level: 40 mg/L (therapeutic) Valproic acid level: 60 mg/L (therapeutic) Lacosamide level: 12 mg/L (therapeutic)
ICU Day 6
Vitals & Clinical Data
BP: 132/71 (91) HR: 87 RR: 13 SpO2: 97% on room air Temp: 97.2 CIWA: 2-3 Keppra level: 40 mg/L (therapeutic) Valproic acid level: 60 mg/L (therapeutic) Lacosamide level: 12 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
status epilepticus case study
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Transcript
status epilepticus case study
start
Status epilepticus
You are the NP working covering the night shift for a mixed neurology/neurosurgery ICU. You get a page to consult on a patient who just arrived to the ED to evaluate for admission. Patient Profile: 42 year old male 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Next
Patient Info
Vitals
Patient Info
Vitals & Clinical Data
Patient Info
Vitals
Patient Info
Vitals
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Perfect! Burst suppression can be accomplished within 24 hours, however weaning from therapeutic benzos is recommended to be a gradual 12-24 hour taper after 24-48 hours of burst suppresion, with close monitoring for return of seizure activity. Additionally, we want to ensure any maintenance AEDs (Keppra, for our patient) are therapeutic before weaning, so we anticipate our patient to spend at least a couple days in the ICU.
Patient Info
Vitals & Clinical Data
Lets dive into this! Burst suppression can be accomplished within 24 hours, however weaning from therapeutic benzos is recommended to be a gradual 12-24 hour taper after 24-48 hours of burst suppresion, with close monitoring for return of seizure activity. Additionally, we want to ensure any maintenance AEDs (Keppra, for our patient) are therapeutic before weaning, so we anticipate our patient to spend at least a couple days in the ICU.
Patient Info
Vitals & Clinical Data
Correct! We will want to begin weaning the midazolam slowly to avoid refractory seizures. Keppra is still therapeutic.
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
Strong work! We want to wait 24 hours after resuming the midazolam at it's prior dose before attempting to wean again, so while we wait, we'll optimize AEDs. You decide to order valproic acid with a loading dose followed by continuous infusion. He remains hemodynamically stable with cEEG on. You leave for the day with orders placed for keppra and valproic acid levels to be drawn in 12 hours.
Patient Info
Vitals & Clinical Data
Continue
Patient Info
Vitals & Clinical Data
WEll Done!
Your patient is discharged!
Your judicious early planning for AED management after discharge was well facilitated with scheduled trough levels the AEDs until discharge. You provide a written medication reconciliation, counsel on alcohol cessation and medication management. You ensure there is a follow-up appointment with neurology in one week scheduled prior to discharge. We don't want to do any AED regimen changes during this care transition, and reiterate medication adherance.
Restart
References
Patient Info
Vitals & Clinical Data
Patient Info
Vitals & Clinical Data
References
https://pmc.ncbi.nlm.nih.gov/articles/PMC6095773/ https://seizure.mgh.harvard.edu/wp-content/uploads/MGH_Status_Protocol_01_09_2015.pdf https://pmc.ncbi.nlm.nih.gov/articles/PMC6095773/ https://www.ncbi.nlm.nih.gov/books/NBK580620/ https://www.ncbi.nlm.nih.gov/books/NBK559112/ https://pubmed.ncbi.nlm.nih.gov/35239286/
Restart
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 1
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 88% Temp: 97.3 Blood glucose: 62 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 1
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 94% on NRB Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 88% Temp: 97.3 Blood glucose: 62 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ED Arrival
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) after intubation SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 94% on NRB Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
ICU Day 1
Vitals & Clinical Data
BP: 118/59 (79) HR: 93 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 100% on vent Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ED Arrival
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 88% Temp: 97.3 Blood glucose: 62 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
ICU Day 1
Vitals & Clinical Data
BP: 163/72 (102) HR: 114 RR: 13 SpO2: 94% on NRB Temp: 97.3 Blood glucose: 157 mg/dL Keppra level: undetectable EtOH level: 148 mg/dL
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 132/81 (98) HR: 101 RR: 14 (with VC/AC on vent, PEEP 8, RR 14, Vt 450, FiO2 60%) SpO2: 98% on vent Temp: 97 Keppra level: 30 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 3
Vitals & Clinical Data
BP: 128/78 (95) HR: 96 RR: 14 (PS/CPAP: PEEP 8, RR 8, 30% FiO2) SpO2: 98% on vent Temp: 97 Keppra level: 40 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 6
Vitals & Clinical Data
BP: 132/71 (91) HR: 87 RR: 13 SpO2: 97% on room air Temp: 97.2 CIWA: 2-3 Keppra level: 40 mg/L (therapeutic) Valproic acid level: 60 mg/L (therapeutic) Lacosamide level: 12 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes
ICU Day 6
Vitals & Clinical Data
BP: 132/71 (91) HR: 87 RR: 13 SpO2: 97% on room air Temp: 97.2 CIWA: 2-3 Keppra level: 40 mg/L (therapeutic) Valproic acid level: 60 mg/L (therapeutic) Lacosamide level: 12 mg/L (therapeutic)
ICU Day 6
Vitals & Clinical Data
BP: 132/71 (91) HR: 87 RR: 13 SpO2: 97% on room air Temp: 97.2 CIWA: 2-3 Keppra level: 40 mg/L (therapeutic) Valproic acid level: 60 mg/L (therapeutic) Lacosamide level: 12 mg/L (therapeutic)
Patient Profile
42 year-old-male
Weight: 82 kg Allergies: Penicillin (rash) PMH: epilepsy (takes keppra 500mg BID), HTN, alcohol use disorder ED Report: witnessed tonic-clonic seizure activity at home, unknown duration, more witnessed seizure activity en route for about 8 minutes