Vols. Videos

Management

Last Updated: September 27, 2018

Equivalent Corticosteroid Doses
Quick reference guide for corticosteroid comparison
Generic Steroid Equivalent dose (mg) Anti-inflammatory Potency Mineralocorticoid potency Oral dosing forms (tablet in mg) Duration of Action (hours)
Cortisone 25 0.8 0.8 tab: 25 8-12
Hydrocortisone 20 1 1 tab: 5, 10, 20 8-12
Prednisone 5 4 0.8 tab: 1, 2.5, 5, 10, 20, 50 12-36
Prednisolone 5 4 0.8 tab: 10, 15, 30 12-36
Methylprednisolone 4 5 0.5 tab: 4, 8, 16, 32 12-36
Dexamethasone 0.75 30 0 tab: 0.5, 0.75, 1, 1.5, 2, 4, 6 36-54
Betamethasone 0.6 30 0 solution: 0.6mg/5ml (118mL) 36-54
Fludrocortisone - 15 150 tab: 0.1mg 24-36
  • Potencies are reported relative to hydrocortisone
  • Steroid doses are listed for equivalent glucocorticoid PO / IV doses (IM may differ)
Initial Steps for Status Epilepticus Therapy (Adult)
AED Step Description
1st Line Lorazepam 0.1mg/kg IV @ <2mg/min
2nd Line

Give either simultaneously with above or 1 minute after lorazepam infusion completes:

  1. phenytoin 20mg/kg IV @ <50mg/min
  2. phosphenytoin 20mg/kg IV @ <150mg/min
3rd Line

7% chance of success at stopping seizure:

  1. phenobarbital <20mg/kg IV @ <100mg/min
  2. valproate 15-30mg/kg IV @ <6mg/kg/min
  3. levetiracetam 20mg/kg IV in 15min
Consider: skip 3rd line → intubate → start midazolam, pentobarbital or propofol
Management of Acute Increase in Intracranial Pressure
Step Description
1 Check airway
2 Elevate head of the bed to 30o
3

Osmotic therapy with mannitol 1gm/kg IV or 10-20ml of 23.4% saline

  • Skip if hypotensive, volume depleted, serum osmolality >320mOsm/L
4If resistant / sudden IC-HTN is present → STAT non-contrast head CT
5Drain 3-5ml of CSF if intraventricular catheter is present
6Ensure patient is sedated and paralyzed
7Hyperventilation with bag valve mask (to PaCO2 30-35mmHg)
8Induced coma with pentobarbital 100mg IV or thiopental 2.5mg/kg IV
Stroke Management Timeline
Time
(Hours from symptom onset)
IV tPA

IA tPA

(Consider after IV tPA failure)

Mechanical Embolectomy

(Consider after IV tPA failure)

1
2
3
4
5Up to 4.5hr
6-

Verify

perfusion

prior to

procedure

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8--
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