Department of Neuroscience, Brown University, Providence, RI.
Department of Neurology, Alpert Medical School, Brown University, Providence, RI.
Ann Neurol. 2021 Mar;89(3):604-609. doi: 10.1002/ana.25989. Epub 2020 Dec 22.
Although seizures are common in prehospital settings, standardized emergency medical services (EMS) treatment algorithms do not exist nationally. We examined nationwide variability in status epilepticus treatment by analyzing 33 publicly available statewide EMS protocols. All adult protocols recommend intravenous benzodiazepines (midazolam, n = 33; lorazepam, n = 23; diazepam, n = 24), 30 recommend intramuscular benzodiazepines (midazolam, n = 30; lorazepam, n = 8; diazepam, n = 3), and 27 recommend intranasal benzodiazepines (midazolam, n = 27; lorazepam, n = 3); pediatric protocols also frequently recommend rectal diazepam (n = 14). Recommended dosages vary widely, and first- and second-line agents are designated in only 18 and 2 states, respectively. Given this degree of variability, standardized national EMS guidelines are needed. ANN NEUROL 2021;89:604-609.
尽管癫痫发作在院前环境中很常见，但全国范围内并没有标准化的急诊医疗服务 (EMS) 治疗算法。我们通过分析 33 份公开的全州范围的 EMS 协议，研究了癫痫持续状态治疗的全国范围内的差异。所有成人方案都推荐静脉内苯二氮䓬类药物（咪达唑仑，n = 33；劳拉西泮，n = 23；地西泮，n = 24），30 个方案推荐肌肉内苯二氮䓬类药物（咪达唑仑，n = 30；劳拉西泮，n = 8；地西泮，n = 3），27 个方案推荐鼻内苯二氮䓬类药物（咪达唑仑，n = 27；劳拉西泮，n = 3）；儿科方案也经常推荐直肠内给予地西泮（n = 14）。推荐剂量差异很大，只有 18 个州和 2 个州分别指定了一线和二线药物。鉴于这种程度的差异，需要制定标准化的全国 EMS 指南。
