Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

Status Epilepticus Strabismus 1377

management

■Postpone diagnostic studies until seizures are controlled; follow pro-

tocol, providing assisted ventilation or pressor agents as needed

➣Ensure adequate airway & oxygenation; maintain vital functions

➣Administer thiamine followed by 50% dextrose IV (to counteract

possible underlying hypoglycemia)

➣Administer diazepam or lorazepam IV; repeat after 5 min if nec-

essary to control seizures in short term

➣Administer phenytoin IV or phosphenytoin to control seizures in

longer term (regardless of response to diazepam or lorazepam);

monitor ECG & blood pressure; avoid glucose-containing solu-

tions w/ phenytoin

➣If status continues, give further phenytoin or phosphenytoin IV

w/o delay

➣If status continues, give phenobarbital IV

➣If status continues, induce anesthesia w/ midazolam, propofol

or pentobarbital IV; will require ventilatory assistance; EEG is

needed to monitor depth of anesthesia & to determine whether

seizures continue (if pt is pharmacologically paralyzed); lighten

anesthesia level after 12 hr unless seizures recur

specific therapy

■Seizures managed as above; specific therapy directed at underlying

cause

follow-up

■Depends on underlying cause

complications and prognosis

■Delay in initiating effective treatment may lead to fatal outcome or

to residual neurologic deficits (eg, cognitive deficit)

STRABISMUS

WILLIAM V. GOOD, MD

history & physical

History

■Congenital esotropia is usually noted in the first 4 months of life.

Accommodative esotropia onset at 1 1/2 to 3 years. Intermittent

exotropia usual onset after 3 years. Vertical strabismus usually

acquired (e.g. Graves disease, blowout fracture).