Protocols - Hemorio

TREATMENT OF CONVULSIVE EPISODES – GRAND MAL SEIZURES
0-5
Minutes
20-60
Minutes
> 60
minutes
Diazepan EV – 0,1 a 0,3 mg/Kg (dose without dilution). It may be repeated every 10 minutes
Oxygen through nasal cannula or masks; to put the head for optimal strength of airways; intubation (if
necessary); oximetry.
Labs exams: electrolytes, glucose, urea, creatinine, complete blood test, toxicological profile, DAE
serum level, gasometry.
Phenitoine via EV - 15 a 20 mg/Kg – loading dose, administrate at 30 minutes (dilute on Saline)
Attention: EEG, ECG and BP monitoring
Phenitoine – 5 mg/Kg/day additional dose up to maximum of 30 mg/Kg (dilute on Saline)
Pentobarbital - 15 mg/Kg IV (6-25 mg/Kg/h), initial dose, monitoring through EEG until the crises stop.
Continue infusion at 1,5 mg/Kg/h, slowing down the speed every 4-6 hours.
OR
Midazolam - 0,2 mg/Kg with continuing infusion of 0.05 to 0.4 mg/Kg/h –EEG Monitoring
OR
Propopol - 1-3 mg/Kg followed by continuing infusion of 1-6mg/Kg/h.
12. OPHTHALMOLOGIC FOLLOW-UP
MAIN OPHTHALMOLOGIC CHANGES
Several ophthalmologic changes may be found according to falciform disease subgroup. The most common
are “comma sign” in bulbar conjunctive in patients SS and facilform retinopathy, in the exam the fundus of
the eye.
Non-Proliferative Retinopathy: more common in SS patients. It corresponds a group of fundoscopy
manifestations that may be divided according to symptoms presentation. Symptomatic group corresponds
to vascular occlusion of carotid and artery blockage and/or retinal vessels (or its branches). Asymptomatic
group (the most common) included vascular tortuosity, spot like “salmon patch” (hemorrhagic areas), “black
sunburst” (retinal atrophy due to resolution of hemorrhagic areas), iridescence spots (Hemosiderin depot),
rupture of peripheral retinal and, rarely, angioids streaks.
Proliferative Retinopathy: more often in SC and Sthal patients, between 20 to 40 years old. Complication
groups that occurred in a sequential manner, passing through 5 stages at retina peripheral: 1 – occlusion
of peripheral arterioles; 2 – arteriovenous anastomosis; 3 – new vessels and/or new vessels tufts (“sea
fan”); 4 – vitreous hemorrhage; 5 –detached retina. The clinical follow-up and treatment will be defined by
the multiprofessional team at stages 1 and 2. In stage 3, laser photocoagulation is indicated in ischemic
areas as fluorescein angiography founds and/or combined treatment with HU, according to personal
evaluation. Patients that are on stages 5 and/or 5 wll be conducted to perform an ultrasound and follow-up
or surgery (vitrectomy), as individual evaluation.
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