Status Epilepticus A 28-ycar-old man is admitted to the ICU for management of status epilepticus. He has a history of seizures following a traumatic brain injury (TBI) 4 years prior and takes...

Status Epilepticus

A 28-ycar-old man is admitted to the ICU for management of status epilepticus. He has a history of seizures following a traumatic brain injury (TBI) 4 years prior and takes levetiracetam. He has no obvious residual deficits of brain injury except mild to moderate short-term memory loss. Due to his memory loss, his wife manages his medications and reports that he c::onsistently takes his levetiracetam. This morning his wife brought him to the ED after he experienced three seizures within 2 hours, and he had one more seizure in the ED. Soon after admission to the ICU for monitoring, he has a generalized tonic-clonic seizure

What are the initial priorities of care for this patient?

The seizure continues for several minutes, and the physician orders lorazepam. Despite receiving lorazepam, the patient continues to have seizure activity. He is intubated for airway management and a midazolam infusion is started A loading dose of fosphenytoin is administered, and continuous EEG monitoring is initiated.

What is the primary adverse effect a880ciated with foaphenytoin?

Seizure activity stops within 1 hour. The midazolam infusion is weaned over 24 hours with no return of seizure activity. He is successfully e:xtubated and his mental status returns to baseline. He is continued on phenytoin and transferred to the acute tare unit for c:ontinued adjustments of his antiepileptic medications.