- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Part 9.1 Anatomy and physiology
- Part 9.2 Neurological monitoring
- Part 9.3 Sleep disturbance
- Part 9.4 Agitation, confusion, and delirium
- Part 9.5 The unconscious patient
- Part 9.6 Seizures
- Chapter 231 Pathophysiology and causes of seizures
- Chapter 232 Assessment and management of seizures in the critically ill
- Part 9.7 Intracranial hypertension
- Part 9.8 Stroke
- Part 9.9 Non-traumatic subarachnoid haemorrhage
- Part 9.10 Meningitis and encephalitis
- Part 9.11 Non-traumatic spinal injury
- Part 9.12 Neuromuscular syndromes
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
Assessment and management of seizures in the critically ill
- Chapter:
- Assessment and management of seizures in the critically ill
- Author(s):
Thomas P. Bleck
- DOI:
- 10.1093/med/9780199600830.003.0232
In previously conscious patients seizures are usually easily detected. Critically-ill patients are frequently sedated and a proportion are paralysed with neuromuscular blocking agents, in such patients it may be hard or impossible to detect seizures clinically. An urgent electroencephalogram (EEG) should be obtained whenever seizures are witness or suspected, especially if the patient does not rapidly return to baseline, when non-convulsive status epilepticus must be excluded. Unless the cause of the seizure activity is already known, an urgent CT, or MRI is indicated. If central nervous system infection is suspected a lumbar puncture may be needed. Status epilepticus is diagnosed when there is recurrent or continued seizure activity without intervening recovery. Most seizures are self-limiting and stop after 1–2 minutes, seizures that continue for more than 5 minutes should be treated. Treatment priorities for any seizure are to stop the patient hurting either themselves or anyone else. General supportive measures include attention to the airway, breathing, circulation, exclusion of hypoglycaemia and an EEG to exclude non-convulsive status epilepticus. A variety of drugs can be used to terminate seizures; parenteral benzodiazepines are the most commonly used agents although propofol and barbiturates are alternatives. Emergent endotracheal intubation may well be necessary, hypotension can be expected and may need treatment with intravenous fluids and vasopressors.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Part 9.1 Anatomy and physiology
- Part 9.2 Neurological monitoring
- Part 9.3 Sleep disturbance
- Part 9.4 Agitation, confusion, and delirium
- Part 9.5 The unconscious patient
- Part 9.6 Seizures
- Chapter 231 Pathophysiology and causes of seizures
- Chapter 232 Assessment and management of seizures in the critically ill
- Part 9.7 Intracranial hypertension
- Part 9.8 Stroke
- Part 9.9 Non-traumatic subarachnoid haemorrhage
- Part 9.10 Meningitis and encephalitis
- Part 9.11 Non-traumatic spinal injury
- Part 9.12 Neuromuscular syndromes
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care