Episode 94: Mastering seizure pharmacology with Tom Bleck

In this episode of Critical Care Scenarios, hosts Brian Bolling and Brandon Odo interview Dr. Tom Bleck, a neurocritical care expert, about the management of seizures in emergency medicine and critical care. The discussion covers the initial treatment of seizures with benzodiazepines, including the choice of drug (lorazepam vs. midazolam), appropriate dosing strategies, and the importance of rapid EEG assessment. Dr. Bleck provides insights into when to treat seizures, the use of anti-seizure medications like levotriacetam, and alternative treatments such as ketamine. The conversation also addresses the management of refractory status epilepticus, the role of continuous EEG monitoring, and considerations for transferring patients to specialized neuro centers.

Outlines

Part 1: Introduction and Initial Management

Part 2: Second-Line Treatments and Intubation

Part 3: Escalation and Advanced Therapies

Part 4: Transfer and Conclusion

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Critical Care Scenarios

Part 1: Introduction and Initial Management

Introduction to Critical Care Scenarios and Seizure Discussion

Initial Seizure Management with Benzodiazepines

Timing of Treatment and the Role of EEG

Benzo Dosage and Transitioning to Anti-Seizure Medications

Part 2: Second-Line Treatments and Intubation

Second-Line Anti-Seizure Medications and Intubation Considerations

Intubation Strategies and Anesthetic Drug Choices

Ketamine as an Adjunctive Drip and EEG Monitoring Frequency

Part 3: Escalation and Advanced Therapies

Escalating Anti-Seizure Medications and Alternative Treatments

Treatment of Focal Seizures and Advanced Therapies

Part 4: Transfer and Conclusion

Transfer Criteria and Final Thoughts

Episode 94: Mastering seizure pharmacology with Tom Bleck

Critical Care Scenarios

Part 1: Introduction and Initial Management

00:00Introduction to Critical Care Scenarios and Seizure Discussion

Introduction to Critical Care Scenarios and Seizure Discussion

01:13Initial Seizure Management with Benzodiazepines

Initial Seizure Management with Benzodiazepines

07:25Timing of Treatment and the Role of EEG

Timing of Treatment and the Role of EEG

16:14Benzo Dosage and Transitioning to Anti-Seizure Medications

Benzo Dosage and Transitioning to Anti-Seizure Medications

Part 2: Second-Line Treatments and Intubation

23:23Second-Line Anti-Seizure Medications and Intubation Considerations

Second-Line Anti-Seizure Medications and Intubation Considerations

31:01Intubation Strategies and Anesthetic Drug Choices

Intubation Strategies and Anesthetic Drug Choices

37:04Ketamine as an Adjunctive Drip and EEG Monitoring Frequency

Ketamine as an Adjunctive Drip and EEG Monitoring Frequency

Part 3: Escalation and Advanced Therapies

44:17Escalating Anti-Seizure Medications and Alternative Treatments

Escalating Anti-Seizure Medications and Alternative Treatments

52:05Treatment of Focal Seizures and Advanced Therapies

Treatment of Focal Seizures and Advanced Therapies

Part 4: Transfer and Conclusion

57:01Transfer Criteria and Final Thoughts

Transfer Criteria and Final Thoughts