What are the daily notes for a patient with status epilepticus in the Intensive Care Unit (ICU)?

From the Guidelines

Daily notes for a patient with status epilepticus in the ICU should include vital signs, neurological status, ventilator settings, and current anti-seizure medication regimen, with a focus on monitoring the response to treatment, including lorazepam, levetiracetam, and phenobarbital, as outlined in the management guidelines 1. When managing a patient with status epilepticus, it is crucial to closely monitor their vital signs, including temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation, as well as their neurological status, including GCS score, pupillary responses, and seizure activity frequency, duration, and type.

• The patient's ventilator settings should be documented if they are intubated, and their current anti-seizure medication regimen, including doses and timing, should be clearly outlined.
• The response to treatment should be documented, including whether seizures have stopped clinically and electrographically via continuous EEG monitoring, as recommended in the guidelines for non-convulsive status epilepticus 1.
• Laboratory values, such as anti-seizure drug levels, electrolytes (particularly sodium, calcium, magnesium), renal and liver function, and any signs of infection, should be monitored and recorded.
• Hemodynamic stability, fluid balance, nutrition status, DVT prophylaxis, and any complications, such as aspiration pneumonia or rhabdomyolysis, should also be noted.
• The overall treatment plan, including clear goals, such as transitioning from IV to oral anti-seizure medications once seizures are controlled for 24-48 hours, should be outlined, taking into account the management guidelines for paediatric patients receiving chimeric antigen receptor t cell therapy 1.
• The medication regimen may include lorazepam 0.05 mg/kg (maximum 1 mg) intravenous (i.v.) every 8 hours for 3 doses, levetiracetam 15 mg/kg (maximum 1,500 mg) i.v. every 12 hours, and phenobarbital 1–3 mg/kg i.v. every 12 hours, as recommended in the guidelines 1.

From the FDA Drug Label

The treatment of status, however, requires far more than the administration of an anticonvulsant agent. It involves observation and management of all parameters critical to maintaining vital function and the capacity to provide support of those functions as required. Ventilatory support must be readily available. The use of benzodiazepines, like lorazepam injection, is ordinarily only one step of a complex and sustained intervention which may require additional interventions (e.g., concomitant intravenous administration of phenytoin). Because status epilepticus may result from a correctable acute cause such as hypoglycemia, hyponatremia, or other metabolic or toxic derangement, such an abnormality must be immediately sought and corrected. Furthermore, patients who are susceptible to further seizure episodes should receive adequate maintenance antiepileptic therapy Any health care professional who intends to treat a patient with status epilepticus should be familiar with this package insert and the pertinent medical literature concerning current concepts for the treatment of status epilepticus.

The daily notes for a patient with status epilepticus in the ICU should include:

• Vital signs: monitoring of vital signs, including respiratory rate, heart rate, and blood pressure
• Seizure activity: documentation of any seizure activity, including frequency, duration, and severity
• Medication administration: record of administration of lorazepam and any other medications used to treat status epilepticus, including dosage and timing
• Ventilatory support: documentation of ventilatory support, including type and settings of ventilation
• Laboratory results: monitoring of laboratory results, including blood glucose, electrolytes, and other relevant tests
• Neurological status: assessment of neurological status, including level of consciousness and any changes in mental status 2
• Airway management: documentation of airway management, including any interventions to maintain a patent airway
• Cardiovascular status: monitoring of cardiovascular status, including cardiac rhythm and blood pressure The patient's condition should be closely monitored, and any changes in status should be promptly addressed. Consultation with a neurologist may be necessary if the patient fails to respond to treatment or if there are any concerns about the patient's condition 2.

From the Research

Daily Notes for a Patient with Status Epilepticus in the ICU

The following are key points to consider when taking daily notes for a patient with status epilepticus in the ICU:

• Seizure activity: Monitor and record any seizure activity, including the frequency, duration, and severity of seizures 3, 4, 5, 6, 7
• Medication administration: Record the administration of benzodiazepines, antiseizure medications, and other treatments, including dosages and timing 3, 4, 5, 6, 7
• Vital signs: Monitor and record vital signs, including temperature, blood pressure, heart rate, and respiratory rate 3, 4, 6
• EEG results: Record the results of electroencephalography (EEG) monitoring, including any changes in seizure activity or brain wave patterns 3, 4
• Underlying cause: Investigate and record the underlying cause of status epilepticus, including any potential triggers or contributing factors 3, 4, 5, 6
• Treatment response: Monitor and record the patient's response to treatment, including any improvements or worsening of seizure activity 3, 4, 5, 6, 7
• Complications: Record any complications that arise, including respiratory depression, cardiac arrhythmias, or other systemic issues 3, 4, 6

Key Considerations

Some key considerations when taking daily notes for a patient with status epilepticus in the ICU include:

• The importance of rapid administration of benzodiazepines and antiseizure medications to control seizure activity 3, 4, 5, 6, 7
• The need for continuous monitoring of seizure activity and vital signs to adjust treatment as needed 3, 4, 6
• The potential for refractory or super-refractory status epilepticus, which may require alternative treatments or interventions 3, 4
• The importance of investigating and addressing the underlying cause of status epilepticus to guide treatment and improve outcomes 3, 4, 5, 6