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Guía de manejo medico y farmacologico del estatus epiléptico

Guía de manejo medico y farmacologico del estatus epiléptico

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Published by HSBCalidad

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Published by: HSBCalidad on Apr 16, 2013
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03/02/2014

 
 Mftm Eiurck Fckcb` Qck% 08 Ec% = Bmrzc Vupkibietc .=?=' 0<==
PIVYBIE
Ik bmeioc jik istmtus ipgkçptgfc riqugiri qui si nmhm gegfgmkbieti uem rípgjm istm`gkgzmfgöe jik pmfgieti y prcfijirie acrbm gebijgmtm fce ik fcetrck ji kms frgsgs%Kcs mftumkis prctcfckcs ji istmtus ipgkçptgfc istíe rifcbiejmejc getirviegr bís tibprmembieti m kcs pmfgietis
fce frgsgs ipgkçptgfms qui ec si fcetrckme aífgkbieti+ fce ik e ji jgsbgeugr msâ km bcrtmkgjmj+ fcbcr`gkgjmj y tgibpcji istmefgm ncspgtmkmrgm% Km itgckchâm is uec ji kcs bmycris gejgfmjcris qui jieie ik prceöstgfc jik pmfgieti%Kcs aírbmfcs metgipgkçptgfcs y meistçsgfcs nme jibcstrmjc ngstörgfmbieti su ifmfgm4 sge ib`mrhc nmstm ue 6<)
ji kcs pmfgietis puijie sir riarmftmrgcs mk trmtmbgietc fceviefgcemk%Ie kms jcs ÿktgbms jçfmjms si nme nifnc isauirzcs pcr biocrmr kcs isquibms ji bmeioc ie pmfgieti riarmftmrgcs cec+ getrcjufgiejc euivcs aírbmfcs metgipgkçptgfcs ji usc getrmviecsc fcbc sce ik mfgjc vmkprcgfc+ kivitgrmfitmb+tcpgrmbmtc y bís rifgietibieti kmfcsmbgjm% Km gejgfmfgöe y pmpik ji istcs bijgfmbietcs fmjm viz hmem bmycr
mfiptmfgöe ie kcs jgmhrmbms ji uoc ji trmtmbgietc ie ik istmtus ipgkçptgfc%Ik pmpik auejmbietmk ji kcs rihgstrcs ikiftrciefiamkchrmfcs prckcehmjc c gjimkbieti ji QgjicIIH .vgjicti
"kibitrgm' y su kifturm pcr pmrti ji pirscemk ietriemjc ie ipgkipsgm+ nme kchrmjc fce çxgtc jitiftmr y bcegtcrgzmr
gefkusc mftgvgjmj ipgkçptgfm su`"fkâegfm c sutgk+ km fumk si puiji prisietmr ji acrbm fcetgeum c getirbgtieti uem viz
qui km mftgvgjmj bctcrm ivgjieti jik istmtus ipgkçptgfc nm jismpmrifgö c ec si nmfi fkmrmbieti ivgjieti%
Vi ispirm qui kms rifcbiejmfgceis ji isti fmpâtukc sime fcesgjirmjms fcbc uem huâm ie ik sgstibm ji smkuj Fckcb
"`gmem ie tcjcs kcs egvikis ji mtiefgöe qui ji uem bmeirm u ctrm+ istíe gevckufrmjcs ie ik bmeioc ji pmfgietis fce
frgsgs ipgkçptgfms+ ispifâfmbieti ie kc fcefiregieti mk istmtus ipgkçptgfc%
\MKM@PMV FKMQIV%
Ipgkipsgm+ Fcevuksgceis+ Itgckchâm+ Istmjc ipgkçptgfc .JiFV'%
Xmktir Hcezíkiz+ Oisÿs Nireíe Pcjrâhuiz%
Bmeioc bçjgfc y amrbmfcköhgfc jik istmtus ipgkçptgfc% MftmEiurck Fckcb` 0<==408?67":1'%
VYBBMPW 
 Zni stmtus ipgkiptgfus trimtbiet riqugris prcbpt getirvietgce tc fcetrck tni hieirmk pmtgiet‗s fcejgtgces mej sigzuris% Zni mftumk stmtus ipgkiptgfus hugjis mri rifcbbiejgeh imrkgir bmemhibiet ge tirbs ca tgbi ge pmtgiets wgtn ectsigzuris fcetrck+ tniri`y rijufgeh bcrtmkgty+ fcbcr`gjgty mej ncspgtmk stmefi% Zni stmtus ipgkiptgfus itgckchy gs cei
ca tni `ghhist gejgfmtcrs tnmt jiei tni pmtgiet‗s prchecsgs% Metgipgkiptgf jruhs mej meistnitgfs nmvi ngstcrgfmkky prcvie iaaiftgvi+ `ut up tc 6<) ca pmtgiets bmy `i riarmftcry 
tc fcevietgcemk trimtbiet% Ge tni kmst twc jifmjis tniri nmvi `iie iaacrts tc gbprcvi trimtbiet ge riarmftcry crect"riarmftcry stmtus ipgkiptgfus+ getrcjufgeh eiw metgipgkiptgf jruhs sufn ms vmkprcgf mfgj+ kivitgrmfitmb+ tcpgrm"bmti+ mej bcri rifietky kmfcsmbgji% Zni gejgfmtgce mej rcki ca tnisi jruhs mri gefrimsgehky hmgeij mffiptmefi getni stmtus ipgkiptgfus trimtbiet mkhcrgtnbs%
Bmeioc bçjgfc y amrbmfcköhgfc jikistmtus ipgkçptgfc
Bijgfmk bmemhibiet ca stmtus ipgkiptgfus
 Xmktir Hcezíkiz+ Oisÿs Nireíe Pcjrâhuiz
 
Pifg`gjc? 6#<=#==% Pivgsmjc? 6#<=#==% Mfiptmjc? 6#<=#==%
 Xmktir Hcezíkiz+ BJ%
Eiuröckchc+ Ipgkiptökchc% Auejmfgöe FmrjgcGeametgk"GF%
 Oisÿs Nireíe Pcjrâhuiz+
BJ% Eiurcsgökchc% Oiai\csthrmjc Eiurckchâm% Yegvirsgjmj jik Pcsmrgc
@chctí%
Fcrrispcejiefgm?
 
 whseiurckLymncc%fcb
Pivgsgöe
 
Bmeioc bçjgfc y amrbmfcköhgfc jik istmtus ipgkçptgfc
GEZPCJYFFGÖE
Ie kms ÿktgbms jcs jçfmjms nme nm`gjc mvmefisgbpcrtmetis ie ik fmbpc ji km gevistghmfgöe qui nmefukbgemjc ie ue biocr ietiejgbgietc y trmtmbgietc
jik istmtus ipgkçptgfc% Yec ji kcs hrmejis kchrcs istírikmfgcemjc fce kcs euivcs getietcs ie uegfmr kmjiegfgöe `msmjm ie km jurmfgöe ji km frgsgs+ kc qui nmpirbgtgjc getirviefgceis amrbmfcköhgfms bís ifmfis
ie kcs fmbpcs pri"ncspgtmkmrgc y ncspgtmkmrgc .sirvg"fgcs ji urhiefgms y uegjmjis ji fugjmjc getiesgvc'%
Kcs mvmefis tifecköhgfcs nme geugjc ie km
jitiffgöe ji pmfgietis fce mftgvgjmj ipgkçptgfm
su`"fkâegfm ie kms uegjmjis ji fugjmjc getiesgvc y 
nme kchrmjc jitirbgemr qui km bcrtmkgjmj fcetgeum
sgiejc ikivmjm m pismr ji km rípgjm jitiffgöe% Ji mkkâkm gbpcrtmefgm ji scspifnmr i gjietgfmr isti tgpcji pmtrceis ie kcs trmzmjcs ikiftrciefiamkchrífcs%
Fm`i rismktmr qui km suprisgöe ji km mftgvgjmj bctcrm
ec sghegfm eifismrgmbieti km fismfgöe fcbpkitm ji
km mftgvgjmj ipgkçptgfm firi`rmk .='%Vce vmrgcs kcs egvikis y kms cpcrtuegjmjis jimtiefgöe pmrm kcs pmfgietis qui prisietme frgsgsipgkçptgfms% Ghumkbieti jgairietis sce kcs gejgvgjucsgevckufrmjcs ie ik fcetrck ji km mftgvgjmj ipgkçptgfm%
 M fcetgeumfgöe si jieie kcs tris egvikis ji mtiefgöe
ji pmfgietis fce istmtus ipgkçptgfc fcevuksgvc%
Bmeioc \ri"ncspgtmkmrgc ie mjuktcs
Km bmycrâm ji kms vifis kcs prgbircs ie m`crjmr
kcs pmfgietis fce frgsgs ipgkçptgfms sce kcs ambgkgmris%Kmbietm`kibieti ec sce bufncs kcs rifurscs jikcs qui jgspceie kms ambgkgms ie fmsc ji prisietmrsiue istmtus ipgkçptgfc+ ixfiptc mquikkcs qui ym nmesgjc gestrugjcs ie km utgkgzmfgöe ji supcsgtcrgcs ji
jgmzipmb riftmk jmjm km ngstcrgm fkâegfm jik pmfgieti.0":'% Is msâ fcbc ik pirscemk pmrmbçjgfc is ue mftcr
 Zni auejmbietmk rcki ca prckchui ikiftrciefipnmkchrmbs cr fcetgeucus QgjicIIH rifcrjs+ getirpritij `y trmgeijpirsceeik ge ipgkipsy4 nmvi sncwe suffiss tc jitift mej bcegtcr ivgjiet fkgegfmk sigzuris cr su`tki gftmk mftgvgty+ wngfnbmy cffur fcetgeucusky cr getirbgttietky+ wnie tni sigzuris bctcr mftgvgty nms jgsmppimrij cr gs jgafukt tc sii%
 Zngs fnmptir rifcbbiejmtgce wgkk `i fcesgjirij ms m hugji acr mkk kiviks ge tni Fckcb`gme nimktn systib tnmt gs
gevckvij ge bmey wmys ge tni bmemhibiet ca pmtgiets wgtn ipgkipsy+ spifgfmkky rihmrjgeh tni stmtus ipgkiptgfus%DIW XCPJV%
Ipgkipsy% Vigzuris+ Itgckchy+ Vtmtus ipgkiptgfus .BiNV'%
Xmktir Hcezíkiz+ Oisÿs Nireíe Pcjrâhuiz%
Bijgfmk bmemhibiet ca stmtus ipgkiptgfus% Mftm Eiurck Fckcb` 0<==408?67":1'%
prgefgpmk ie km gjietgfmfgöe y trmtmbgietc ji kcspmfgietis jurmeti kms amsis geâfgmkis ji km ietgjmj .='%
Ik bmeioc `ísgfc istm jmjc pcr vmkcrmfgöe ji
km vâm mçrim+ km rispgrmfgöe y km fgrfukmfgöe .M@F'%Gebijgmtmbieti jispuçs+ istí oustgfmjm km suffgöe
ji kms sifrifgceis+ km mjbgegstrmfgöe ji cxghiecsupkibietmrgc+ mffisc getrmviecsc i gegfgc ji metgi"pgkçptgfcs% Vi ji`ie gejmhmr sgtumfgceis ji mktcrgishc tmkis fcbc ngstcrgm ji ieairbijmj fmrjgmfm+ngstcrgm ji frgsgs ipgkçptgfms privgms+ ib`mrmzc+jgm`itis+ trmubm c sc`rijcsgs ji fumkqugir aírbmfc
c töxgfc% Jurmeti ik trmespcrti ik pmfgieti ji`i
rifg`gr scpcrti ji kcs sghecs vgtmkis+ jisfmrtmejcmjibís sgtumfgceis ji rgishc fcbc ngpchkgfibgm cngpcxibgm% Mquikkcs pmfgietis qui tgieie ngstcrgm
ji jgm`itis ec ji`ie rifg`gr hkufcsm ibpârgfmbietiy si ji`irí ispirmr fcerbmfgöe ji kcs meíkgsgs ji
hkufcbitrgm .='% M jgairiefgm ji kcs pmfgietis fcetrmubms bijukmris ec nmy gejgfmfgöe pmrm ik usc jifckkmris c fumkqugir ctrc tgpc ji gebcvgkgzmfgceis
bijukmris4 si nm jibcstrmjc qui kcs fcstcs y tgib
"
pcs ji trmtmbgietc si ikivme ie firfm jik ==6) mk
tcbmr istms prifmufgceis .9'% Mkkjrijhi y fckm`crmjcris ie ue istujgc jc`kifgihc \NZVI .\ri"ncspgtmk Zrimtbiet ca VtmtusIpgkiptgfus' .='+ jibcstrmrce ie pmfgietis fcefrgsgs ipgkçptgfms bmycris m 9 bgeutcs+ qui ik kcrm"
zipmb kchrm`m fcetrckmr ik 1<) ji kms frgsgs metisji km kkihmjm mk sirvgfgc ji urhiefgms vs :0) fcejgmzipmb y 0=) fce pkmfi`c% Km prc`m`gkgjmj ji
tirbgemr ue istmtus ipgkçptgfc fce kcrmzipmb aui
jik :%> .GF 79) =%7"=6)' vs pkmfi`c y ji 0%6 GF79) .=%<"9%7' fce jgmzipmb vs% pkmfi`c4 ec nu`cjgairiefgms sghegfmtgvms mk fcbpmrmr kcrmzipmb vs
jgmzipmb% Ie isti bgsbc istujgc si jibcströ quiik pcrfietmoi ji fcbpkgfmfgceis fmrjgcvmsfukmris y 
rispgrmtcrgms aui ji =<) pmrm kms `iezcjgmfipgems vs 00) fce pkmfi`c%
 
 Mftm Eiurck Fckcb` Qck% 08 Ec% = Bmrzc Vupkibietc .=?=' 0<==
\rivgmbieti ik Qitirmes Maamgrs QM' Fcpirmtgvi
Vtujy .1' nm`âm jibcstrmjc qui ik kcrmzipmb irm bís
sihurc y iaiftgvc qui ik jgmzipmb GQ m jcsgs ji <+=bhrs#dh fcetrm ctrc hrupc mkimtcrgzmjc m jgmzipmb<+=9bhrs#dh sihugjc ji jcsgs ji aiegtcgem+ => bh#
dh4 c aiec`mr`gtmk+ =9 bh#dh .='% Jcs istujgcs ji
utgkgzmfgöe ji jgmzipmb riftmk vs kcrmzipmb GQ ieik trmtmbgietc ji frgsgs ipgkçptgfms jibcstrmrce quiik jgmzipmb hik riftmk jgsbgeuyi km rifurriefgm jifrgsgs mk tgibpc qui km mjbgegstrmfgöe aui bufnc bís
rípgjm y ifmz .1">'% Msâ si fcefkuyi qui kms `iezc
"jgmfipgems sce sihurms ie ik íb`gtc pri"ncspgtmkmrgcie mjuktcs y ik kcrmzipmb prc`m`kibieti tgiei bmycr
ifmfgm fcbpmrmjc fce ik jgmzipmb GQ .7+=<'% Ik usc
ji `iezcjgmfipgems ie acrbm getrmbusfukmr ec isuem príftgfm hieirmkgzmjm+ si risirvm ie kcs fmscs ji
jgaâfgk mffisc viecsc+ fcbc bijgjm ji mpkgfmfgöe pcr
pirscemk pmrmbçjgfc ie zcems jceji km vmkcrmfgöebçjgfm is pcfc amftg`ki y si ji`i rimkgzmr meti kmpirsgstiefgm ji kcs ivietcs fcevuksgvcs c ie kcs egýcs.7'% Ie hieirmk si mfiptm qui ie nubmecs km prgbirm
kâeim ji bijgfmbietcs fcetrckm firfm jik ><) ji kmsfrgsgs ie kcs prgbircs 6< bgeutcs y sckmbieti ik :<)jispuçs ji kms 0 prgbirms ncrms .0+=0+=6'%
Ie Fckcb`gm ec ixgsti km prisietmfgöe iejcvi"ecsm ji kcrmzipmb+ tieibcs jgspceg`ki+ jgmzipmb.=:'+ fkcemzipmb+ .=9"=8' c bgjmzckme% Ik usc jifkcemzipmb getrmviecsc isti aui gevistghmjc ie ueistujgc m`girtc ie 0: pmfgietis fce istmtus fcevuk"sgvc fce km mjbgegstrmfgöe ji ="0 bhrs ji fkcemzi"pmb si fcetrckmrce kms frgsgs% Ik tgibpc bijgc pmrmkchrmr ik fcetrck ji kms frgsgs aui ji =%89 bgeutcs fce
ecrbmkgzmfgöe c biocrâm ie ik ikiftrciefiamkchrmbm
pcst gftmk+ kcs sghecs vgtmkis bijgjcs ec suargirce vmrgmfgöe bmycr% Kcs iaiftcs sifuejmrgcs c`sirvmjcs
auirce scbeckiefgm ie ik :<) ji kcs pmfgietis+ iemkhuecs pmfgietis .=0%9)' si c`sirvö mhgtmfgöe psg
"fcbctcrm ie ik istmjc pcst"gftmk .=>'% Ik fkcemzipmbis uem nirrmbgietm ÿtgk ie ik bmeioc ji kms frgsgs% Ikusc ji fkcemzipmb iejcviecsc tgiei ue tgibpcgetirbijgc ji gegfgc ji km mffgöe metgfcevuksgvmetiietri kcrmzipmb y bgjmzckmb .=7'%Dugsbm y Pcgei .0<' ie ue istujgc pgkctc ji >pmfgietis fce istmtus ipgkçptgfc+ jibcstrmrce qui=<< m 0<< bh GQ ji prcpcack GQ auirce sihurcs mksir mjbgegstrmjcs .ixfiptc pcr kivi jgsbgeufgöe jifgarms ji tiesgöe mrtirgmk sgstökgfm' pmrm km suprisgöeji km mftgvgjmj ipgkçptgfm jurmeti km mtiefgöe pri"ncspgtmkmrgm% Kcs pmfgietis pirbmeifgirce ie fcbm
jurmeti firfm ji 6 ncrms+ fce uem jurmfgöe prcbijgcji ncspgtmkgzmfgöe ji 6 jâms% Isti istujgc jibuistrm
mktiremtgvms getirismetis qui eifisgtme sirgis ji fmscsbmycris metis ji gbpkibietmrsi ji bmeirm rutgemrgm%
Bmeioc ie ik Virvgfgc ji Yrhiefgms
 Mk gehrismr mk sirvgfgc ji urhiefgms si ji`imjbgegstrmr uem `iezcjgmfipgem+ sg çstm ym nm sgjcmjbgegstrmjm pcr ik pirscemk pmrmbçjgfc si puijiripitgr km jcsgs .1'% Mjibís kcs pmfgietis ji`ierifg`gr =<< bh ji tgmbgem y 9< bk ji jixtrcsm mk
9<) sg km hkufcsm is `mom c gejitirbgemjm ispifgmk
"bieti meti km scspifnm ji mkfcnckgsbc% Vi ji`ienmfir prui`ms pmrm jitirbgemr egvikis ji ikiftrckgtcs.scjgc+ fmkfgc+ bmheisgc+ pctmsgc+ aösacrc'+ auefgöebgcfírjgfm+ F\D tctmk+ hmsis mrtirgmkis+ egvikis jimbcegc+ trmesmbgemsms+ frimtgegem+ ífgjc kíftgfc+nibchrmbm tctmk y ixíbieis pmrm jisfmrtmr töxgfcs%Ie mquikkcs pmfgietis fce metifijietis ji ipgkipsgmji`ie c`tieirsi kcs egvikis ji metgipgkçptgfcs% Vimfcesiom ngjrmtmfgöe GQ pmrm ivgtmr jmýc riemk pcrrm`jcbgckgsgs% Kms gbíhieis firi`rmkis muequi jgs"futgjms istíe gejgfmjms ji mfuirjc mk frgtirgc bçjgfc%Km puefgöe kub`mr si moustm m frgtirgc bçjgfc ie ikbcbietc ji km ivmkumfgöe+ sge ib`mrhc ec si ji`irimkgzmr pcr prctcfckc%
Vikiffgöe ji metgipgkçptgfcs
 Zcjcs kcs pmfgietis fuyms frgsgs sime supirgcrism kcs 9 bgeutcs ji`ie rifg`gr mjibís ji kms `iezc"jgmfipgems ue metgipgkçptgfc+ vir bijgfmfgceis ji
sihuejm kâeim ie km hurm =% Muequi ec ixgstie istu
"
jgcs fkâegfcs jc`ki fgihc c hrmejis sirgis ji fmscs+
si nme mjmptmjc prctcfckcs ji trmtmbgietc .1+ 0<+
0='% Ik jgmhrmbm ji uoc pmrm ik bmeioc jik istmtus
ipgkçptgfc ji km AFG si msibiom m kcs prctcfckcs
getiremfgcemkis ji tirfir y fumrtc egvik .Aghurm ='4
kms jcsgs ji gegfgc y bmetiegbgietc ji bijgfmfgc"eis utgkgzmjms fcbÿebieti ie istmtus ipgkçptgfc sigkustrme ie km tm`km =%Gjimkbieti si ji`i gegfgmr fce acsaiegtcgem+ kmfumk m jgairiefgm ji km aiegtcgem is ji rípgjm mjbg"
egstrmfgöe .vikcfgjmj ji geausgöe 6 vifis bmycr'+
biecr grrgtmfgöe kcfmk+ c`tiegiejc egvikis sçrgfcs ie
6< bgeutcs vs 6 ncrms fcbpmrmjc fce km aiegtcgem

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