PENATALAKSANAAN KEJANG

Emergency Department Care ABCs should be addressed, as detailed below: Airway management - Administer oxygen. - For patients in status epilepticus or cyanotic, endotracheal intubation using rapid sequence intubation (RSI) should be strongly considered. Establish large-bore intravenous access. Initiate rapid glucose determination and treat appropriately. Consider antibiotics with or without antiviral agents, depending on the clinical situation. The goal of treatment is to control the seizure before neuronal injury occurs (theoretically between 20 min to 1 h).

Seizure management in the emergency department is as follows: Initial therapies: 1. Benzodiazepines - Considered first-line therapy Intravenous options include lorazepam, diazepam, and midazolam. If intravenous access cannot be obtained, then IM lorazepam or midazolam, or rectal diazepam can be considered. A common regimen is 0.1 mg/kg of lorazepam (Ativan) IV given at 2 mg/min or 0.2 mg/kg diazepam IV given at 5-10 mg/min. 2. Phenytoin - second-line agent for patients who continue to seize despite aggressive benzodiazepine therapy The recommended dose is 20 mg/kg IV and can be augmented with another 10 mg/kg IV if the patient is still seizing. 3. Valproic acid Effective in treating all forms of seizure Recommended dose of valproic acid is 15-20 mg/kg. 4. Phenobarbital Similar efficacy to lorazepam Recommended dose of phenobarbital is 20 mg/kg, but, like phenytoin, it can be given up to 30 mg/kg for severe refractory seizures.

Continuous infusions: If 2 or more of the initial drug therapies fail to control the seizures, then the next line of treatment includes continuous infusions of antiepileptic medications. 1. Midazolam Midazolam is administered as a 0.2 mg/kg bolus, then continuous infusion of 0.05-2 mg/kg/h. 2. Pentobarbital Pentobarbital is shorter acting than phenobarbital, but it is more sedating. Pentobarbital should be administered in a bolus at 5-15 mg/kg, then continuous infusion of 0.5-10 mg/kg/h as tolerated. 3. Propofol propofol appears to be very effective at terminating seizures. Propofol is administered in a bolus at 2-5 mg/kg, then continuous infusion of 20-100 mcg/kg/min. It is limited by infusion syndrome of hypotension, metabolic acidosis, and hyperlipidemia seen with prolonged infusions.