Rogalski Rachel, Rogalski Andrew
Emergency Department (Ms R. Rogalski), Pharmacy Department (Dr A. Rogalski) University Medical Center of Princeton at Plainsboro.
Adv Emerg Nurs J. 2015 Apr-Jun;37(2):83-94; quiz E2. doi: 10.1097/TME.0000000000000064.
The choice and route of administration of benzodiazepines for the treatment of acute status epilepticus (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 administration 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, inconsistencies in the treatment of acute SE continue to occur in both the prehospital and ED settings.
在院前和急诊科环境中，用于治疗急性癫痫持续状态（SE）的苯二氮䓬类药物的选择和给药途径通常因提供者和机构而异。院前和急诊科护理通常涉及这些药物的肌肉注射、静脉注射或直肠给药。在美国，地西泮、劳拉西泮和咪达唑仑有注射用剂型。为了确定哪种苯二氮䓬类药物和给药途径是成年SE患者的最佳治疗选择，我们对临床试验和SE治疗指南进行了文献综述。对于成人SE的初始治疗，推荐静脉注射劳拉西泮作为首选药物。然而，有证据表明，肌肉注射咪达唑仑在院前环境中至少具有同等疗效，可能更适合在这种环境中使用。尽管有多项临床试验和治疗指南的支持，但急性SE的治疗在院前和急诊科环境中仍存在不一致的情况。
