Example drug administration protocol
There are different views as to the exact order of the administration of these drugs. For example, diazepam can be repeated in 5mg doses until a max of 20mg has been administered.
The doses given are a guide - always check the BNF!
- 0 mins: lorazepam 4 mg (IV) or diazepam 10 mg (IV or PR) - slow boluses (<2mins)
- 10 mins: lorazepam 4 mg (IV) or paraldehyde (PR) (or repeat diazepam)
- 20 mins: phenytoin slow-infusion (IV - separate line to diazepam), at rate: <50mg/min.
- 30 mins: ITU (consider anaesthesia, e.g. propofol)
Notes:
1. Lorazepam can cause respiratory arrest. Have your resuscitation equipment to hand. Administer the drug slowly (over 1-2 minutes)
2. Phenytoin also needs to be administered with care and, in particular, ECG monitoring.
3. In alcoholic or malnourished patients, consider 250mg thiamine IV (over 10mins).
4. Always correct other abnormalities, such as hypotension.
5. Other drugs to consider at a later stage, include muscle relaxants.
Investigation
A: CVA (CT, clotting)
E: idiopathic epilepsy (diagnosis of exclusion)
I: HI, meningoencephalitis (temp, CRP, FBC, blood cultures), tumour (CT)
O: inc. EtOH & withdrawl (LFTs), tricylic antidepressants (toxicology screen, ABGs)
U: check for: decreased BM, Na (U&E), Ca2+, Mg2+, O2 (ABG), eclampsia (abdo examination)
Double-check!
S: sugar, steroids (dexamethasone 10mg (IV) for oedema around a cerebral tumour, etc)
T: thiamine (250 mg (IV) if EtOH / malnourished
O: OD (tox. screen)
P: pregnant (pelvic mass, urinary B-hCG)
