IBCC Episode 76 - Status Epilepticus

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam Thomas discuss status epilepticus, defining it as a seizure lasting over five minutes or multiple seizures without regaining consciousness in between. They differentiate between generalized and partial seizures, and delve into refractory and super-refractory status epilepticus. The hosts explore the differential diagnosis, including pseudoseizures, metabolic imbalances, malignancies, infections, vascular issues, trauma, and drug-related causes. They emphasize the importance of a thorough history, neurological exam, and lab investigations. The discussion covers a treatment algorithm, advocating for rapid intervention with benzodiazepines, anti-epileptic drugs like Keppra, and, if necessary, neurolytic intubation using propofol and ketamine. They also touch on alternative treatments like ketogenic diets and the challenges of managing super-refractory cases, including the ethical considerations of barbiturate comas and the utility of continuous EEG monitoring.