| dc.description.abstract | Status Epilepticus is a potentially life threatening emergency, which requires prompt management and treatment. Pre-hospital research into optimal treatments has been historically limited, resulting in guidelines for the setting which are extrapolated from care provided within the emergency department and solely focused on benzodiazepine administration. A systematic review of prehospital research into paramedic provided care was only able to conclude that various benzodiazepines are more effective than placebo and that intramuscular administration of midazolam is noninferior to intravenous lorazepam. Established Status Epilepticus is associated with even greater morbidity and mortality and requires prompt treatment with other anti-epileptic medications where benzodiazepines have failed. Evidence is lacking regarding patient need or its use by paramedics or in the out of hospital setting, despite guidelines recommending administration within a timeframe which is almost exclusively within the prehospital phase of care. The intention of this review was to establish a frequency of established status epilepticus within a specific prehospital population, to ascertain whether an alternative anti-epileptic medication may be of benefit. A clinical audit was undertaken over a 3 year period for patients who were with midazolam for status epilepticus by a group of critical care paramedics within an urban UK ambulance service. The audit focused on general seizure management, midazolam administration, complication rates and patient outcomes to ensure the drug was administered safely and legally and that other care was provided in accordance with expected standards. 131 patients were identified for review, where the documentation of clinical care was generally to a high standard and compliant with expected guidelines but where isolated elements were below desired levels and are identified as areas for improvement. IV midazolam was the most common route of administration. The incorrect dose, route and concentration were infrequently documented incorrectly and only on the initial dose. There was a low frequency of significant airway compromise (5%) and hypotension (6%), but it was often that patients required ventilatory support (17%) and very common where patients required some level of airway support at some point (73%). The results support that midazolam is used safely by this team and that care is provided in agreement with local and national guidelines. Within this population where the outcome is known, the incidence of benzodiazepine resistant SE was 4-11%, but where not all patients received a maximum cumulative dose of benzodiazepines. | |