First stage 010 minutes Oxygen and cardiorespiratory resuscitation

It is first essential to assess cardiorespiratory function, to secure the airway, and to resuscitate where necessary. Oxygen should always be administered, as hypoxia is often unexpectedly severe.

Box 6.3 General measures

1

(0-10 minutes)

Assess cardiorespiratory function

Secure airway and resuscitate

Administer oxygen

2

(0-60 minutes)

Institute regular monitoring (see text)

Emergency antiepileptic drug therapy (see text)

Set up intravenous lines

Emergency investigations (see text)

Administer glucose (50 ml of 50% solution) and/or intravenous

thiamine (250 mg) as high potency intravenous Pabrinex where

appropriate

Treat acidosis if severe

3

(0-60/90 minutes)

Establish aetiology

Identify and treat medical complications

Pressor therapy where appropriate

4

(30-90 minutes)

Transfer to intensive care

Establish intensive care and EEG monitoring (see text)

Initiate seizure and EEG monitoring

Initiate intracranial pressure monitoring where appropriate

Initiate long term, maintenance, antiepileptic therapy

These four stages should be followed chronologically; the first

and second within 10 minutes, and stage 4 (transfer to intensive

care unit) in most settings within 60-90 minutes of presentation.

Derived from Shorvon.1

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