Management of uncontrolled convulsions in status epileptics (neurofibromatosis syndrome)
Introduction : Convulsive status epileptics cases are considered an emergency in children especially if convulsions are long lasting without any recovery time between seizures which need immediate management to airway . breathing and circulation to preserve lfe first and then act to control the convulsions which is life threating if prolonged because it may lead to respiratory arrest .
Aim of work : To find a way which can manage the uncontrolled convulsions in status epileptics case .
Methods : I searched the medical sites as pubmed database .cocharne . medscape and others for clinical trials . meta analysis . randomized control studies and researches talking about status epileptics and management should be taken to control the convulsions .
Results : Researchers recommend that after establishment of the patient ABC . we should try to find venous access to give anticonvulent medications .
If there is a venous access we start to infuse 0.1 mg/kg lorazepam as an effective anti convulent ( over 30 : 60 sec ) and then wait .if there is no response within 10 minutes give another dose of lorazepam which is more effective than diazepam and also less respiratory depression . if there is no response within 10 minutes we should turn to phenytoin 18 mg/kg IV and paraldehyd 0.04 ml/kg and wait .
If convulsions persist more than 20 minutes we should use general anesthesia and put the patient on mechanical ventilation in an intensive care unit .
Conclusion : Lorazepam is the best choice anticonvulent and better used in convulsive status epileptics than rectal diazepam if there is a venous access because it has less or even no depressive action on respiration .
If there is no responce or recovery after infusion of different anticonvulsent medications we should save the patient life by using a mechanical ventilator and start other interventions.
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