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Benzodiazepine Selection in the Management of Status Epilepticus A Review

Benzodiazepine Selection in the Management of Status Epilepticus A Review The choice and route of administration of benzodiazepines for the treatment of acute status epilep- ticus (SE) in both prehospital and emergency department (ED) settings often vary by provider and institution. Prehospital and ED care often involves intramuscular, intravenous, or rectal admin- istration of these medications. Diazepam, lorazepam, and midazolam are available as parenteral formulations in the United States. A literature review of clinical trials and SE treatment guidelines was conducted in an attempt to identify which benzodiazepine and route are the best treatment option for adult patients with SE. For initial treatment of SE in adults, intravenous lorazepam is the recommended drug of choice. However, evidence suggests that intramuscular midazolam has at least equal efficacy in prehospital settings and may be more appropriate for use in this environment. Despite the support of multiple clinical trials and treatment guidelines, inconsisten- cies in the treatment of acute SE continue to occur in both the prehospital and ED settings. Key words: benzodiazepine, seizure, status epilepticus NE MILLION emergency depart- 2006). Status epilepticus is a seizure event ment (ED) visits annually in the lasting more than 5 min, or repeated seizure O United States are due to seizure activities for more than http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advanced Emergency Nursing Journal Wolters Kluwer Health

Benzodiazepine Selection in the Management of Status Epilepticus A Review

Advanced Emergency Nursing Journal , Volume 37 (2) – Apr 1, 2015

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Copyright
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1931-4485
eISSN
1931-4493
DOI
10.1097/TME.0000000000000064
pmid
25929219
Publisher site
See Article on Publisher Site

Abstract

The choice and route of administration of benzodiazepines for the treatment of acute status epilep- ticus (SE) in both prehospital and emergency department (ED) settings often vary by provider and institution. Prehospital and ED care often involves intramuscular, intravenous, or rectal admin- istration of these medications. Diazepam, lorazepam, and midazolam are available as parenteral formulations in the United States. A literature review of clinical trials and SE treatment guidelines was conducted in an attempt to identify which benzodiazepine and route are the best treatment option for adult patients with SE. For initial treatment of SE in adults, intravenous lorazepam is the recommended drug of choice. However, evidence suggests that intramuscular midazolam has at least equal efficacy in prehospital settings and may be more appropriate for use in this environment. Despite the support of multiple clinical trials and treatment guidelines, inconsisten- cies in the treatment of acute SE continue to occur in both the prehospital and ED settings. Key words: benzodiazepine, seizure, status epilepticus NE MILLION emergency depart- 2006). Status epilepticus is a seizure event ment (ED) visits annually in the lasting more than 5 min, or repeated seizure O United States are due to seizure activities for more than

Journal

Advanced Emergency Nursing JournalWolters Kluwer Health

Published: Apr 1, 2015

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