Abstracts

Rationale: Objective: To evaluate the use of lorazepam in adult patients in the epilepsy monitoring unit (EMU).Background: Use of benzodiazepines such as lorazepam as a rescue medication for controlling prolonged or frequent seizures to prevent status epilepticus is common practice in the EMU. Despite written protocols, nurses often get confused over the appropriate use of lorazepam. We report our experience on the use of lorazepam in our EMU. Methods: Our protocol states lorazepam 1 mg IV as needed for: generalized tonic clonic seizures >2 minutes; complex partial seizures >5 minutes; or 3 epileptic seizures of any type within 1 hour; dose may be repeated once, total dosage not to exceed 2 mg in one hour; on-call physician to be called after 2nd dose if seizures continue requiring higher dosing. We reviewed the records of consecutive patients admitted to our EMU over 6 months (3/1 to 8/31/18). We defined the treatment as successful when the patients did not require a 2nd dose. Results: During the 6-month period, 91 patients were admitted to our unit, of whom 34 received lorazepam. Of these, 19 were excluded (5 were on scheduled doses for seizure control; 1 received a dose for sedation prior to a MRI; 6 received a prophylactic dose prior to discharge; 4 received a higher dose than protocol; 3 were treated for abnormal EEGs without clinical seizures). Thus, 15 patients were included in the study (11 males, 4 females, age 19-80 years) and 24 doses were given. Nine patients (60%) and 14 doses (65%) did not require a repeat dose. Six (6) events (25%) required the on-call physician to be notified. None of the patients developed status epilepticus. Conclusions: Our protocol for using lorazepam as a rescue medication in the EMU was not only simple for the nurses to follow but also beneficial to prevent status epilepticus. Funding: No funding