Critical EEG Values and Protocols

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Questions and Answers

What do critical values in healthcare generally indicate?

  • Test results indicating a potentially life-threatening condition (correct)
  • The need for routine medical check-ups
  • A patient's satisfaction level with their care
  • A patient's preference for treatment options

According to the reference, what is a potential consequence of failing to act on EEG critical values quickly?

  • Temporary discomfort
  • Slight memory loss
  • Improved cognitive function
  • Permanent brain damage or death (correct)

The reference emphasizes that the longer a seizure continues, the higher the risk for what?

  • Rapid recovery
  • Neurological decline and death (correct)
  • Decreased risk of complications
  • Enhanced cognitive abilities

What percentage of pediatric patients suffered neurological decline at 16% seizure burden per hour?

<p>67% (B)</p> Signup and view all the answers

Seizures can lead to which of the following cardiac complications?

<p>Bradycardia, asystole, or cardiac arrest (D)</p> Signup and view all the answers

According to the reference, what should be monitored alongside EEG, especially in high-risk patients?

<p>ECG (C)</p> Signup and view all the answers

In the ICU and EMU setting, when should the neurologist be alerted?

<p>If a first-ever seizure is detected (B)</p> Signup and view all the answers

In the ICU and EMU, a neurologist should be alerted if a seizure lasts for how long?

<p>More than 5 minutes (A)</p> Signup and view all the answers

In an in-home AEEG setting, who should be notified if a seizure exceeds the protocol threshold?

<p>In-home companion or physician (A)</p> Signup and view all the answers

In an in-home AEEG setting, who should be notified if there is risk of physical injury?

<p>In-home companion or physician (D)</p> Signup and view all the answers

In an in-home AEEG setting, what should be done if there is a risk of physical harm?

<p>Call 911, visit ER, observe (C)</p> Signup and view all the answers

What is one recommendation for policy development?

<p>Define what qualifies as a critical value (A)</p> Signup and view all the answers

According to the reference, what is essential, especially during seizures?

<p>Cardiac monitoring (C)</p> Signup and view all the answers

In the context of EEG, what constitutes a 'critical value' that necessitates immediate action?

<p>Test results indicating a potentially life-threatening condition. (C)</p> Signup and view all the answers

What impact does prolonged delay in addressing EEG-identified electrographic seizures have on patient outcomes?

<p>Possible permanent brain damage or death. (D)</p> Signup and view all the answers

Why is 'time is brain' emphasized related to seizures?

<p>Extended seizure duration leads to increased risk of neurological decline and mortality. (D)</p> Signup and view all the answers

How does increased seizure burden affect pediatric patients?

<p>Neurological decline and increased mortality. (D)</p> Signup and view all the answers

What cardiac complications are most associated with prolonged seizures?

<p>Bradycardia, asystole, or cardiac arrest. (D)</p> Signup and view all the answers

In addition to EEG, what physiological parameter should be closely monitored in high-risk patients?

<p>ECG. (C)</p> Signup and view all the answers

In an ICU or EMU setting, what is the duration threshold from when a neurologist should be alerted about a patient's seizure?

<p>5 minutes (A)</p> Signup and view all the answers

In the context of at-home AEEG monitoring, when should the in-home companion be notified?

<p>When the seizure exceeds the protocol threshold. (B)</p> Signup and view all the answers

In at-home AEEG monitoring, what immediate action should be taken if there is a risk of physical harm?

<p>Immediately contact emergency services (e.g., call 911). (C)</p> Signup and view all the answers

What is a key recommendation for developing effective EEG critical value policies?

<p>Clarifying responsibilities between technicians and physicians. (C)</p> Signup and view all the answers

Why is standardization of communication methods emphasized when developing EEG critical value policies?

<p>To ensure clear, efficient, and reliable relay of critical information. (B)</p> Signup and view all the answers

Beyond immediate intervention, what additional measure significantly contributes to preventing medical errors during EEG monitoring?

<p>Implementing and adhering to a clear protocol. (B)</p> Signup and view all the answers

What constitutes a new seizure type?

<p>A seizure whose characteristics differ from previous seizure events. (C)</p> Signup and view all the answers

When is continuous EEG monitoring implemented?

<p>To continuously watch for seizure activity, especially in high-risk patients. (B)</p> Signup and view all the answers

How should communication methods be standardized?

<p>By clearly defining accepted methods such as phone and EMR. (A)</p> Signup and view all the answers

Why is it essential to set timeframes for detection and notification in EEG protocols?

<p>To guarantee prompt responses to critical EEG findings. (C)</p> Signup and view all the answers

Given the legal implications of failing to act on EEG critical values, what is the primary risk hospitals face?

<p>Liability for poor monitoring or communication delays due to inaction. (B)</p> Signup and view all the answers

What is the financial implication for hospitals shown to have failed to treat during status epilepticus?

<p>Up to $4 million has been awarded for failure to treat status epilepticus in example cases. (A)</p> Signup and view all the answers

What are the final takeaways related to EEG critical values?

<p>Following a clear protocol prevents medical errors and saves lives. (D)</p> Signup and view all the answers

What parameter defines excessive seizure frequency?

<p>The frequency exceeding pre-established protocol thresholds. (B)</p> Signup and view all the answers

Flashcards

EEG Critical Values

Test results indicating a potentially life-threatening condition requiring immediate communication and action.

Examples of EEG Critical Values

Electrographic seizures, status epilepticus, significant baseline changes, and patterns indicating high seizure burden.

Time Is Brain

The principle that longer seizure duration increases the risk of neurological damage and death.

EEG and Cardiac Rhythms

Seizures can lead to cardiac complications like bradycardia, asystole, or cardiac arrest.

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ECG Monitoring with EEG

Monitor ECG alongside EEG, particularly in high-risk patients.

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ICU/EMU: Alert Neurologist If

First-ever seizure, seizure lasting >5 minutes, new seizure type, multiple seizures in an hour, risk of physical harm.

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In-Home EEG: Notify If

Notify a companion or physician if seizure exceeds protocol, excessive frequency, or any physical injury risk.

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In-Home AEEG Possible Actions

Call 911, visit ER, or observe.

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EEG Critical Values Importance

Critical values are life-saving alerts, not optional.

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Tech/Neurologist Actions

Techs and neurologists must act quickly and escalate findings.

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Consequences of Inaction

Failure to report or act on critical EEG values can lead to permanent brain damage or death.

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Seizure Burden Impact

At 16% seizure burden per hour (~9.6 minutes), neurological decline affected 67% of pediatric patients.

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EEG Initiation Timeliness

Delays in EEG initiation in critically ill neonates and children increase mortality.

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Policy Development Elements

Define what qualifies as a critical value, clarify roles, standardize communication, set timeframes, and monitor compliance.

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Legal Repercussions

Failure to act on EEG critical values can lead to permanent injury or death; hospitals held liable for poor monitoring/communication.

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Protocol Importance

Following a clear protocol prevents medical errors and saves lives during EEG monitoring.

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Cardiac Monitoring During Seizures

Cardiac monitoring is essential, especially during seizures, to detect complications like bradycardia or cardiac arrest.

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Study Notes

  • EEG critical values are test results indicating a potentially life-threatening condition, necessitating immediate communication and action.
  • Electrographic seizures, status epilepticus, significant baseline changes, and patterns suggesting high seizure burden are critical values in EEG.
  • Failure to report or act on EEG critical values can lead to permanent brain damage or death.
  • The longer a seizure continues, the higher the risk for neurological decline and death.
  • A 16% seizure burden per hour (approximately 9.6 minutes) led to neurological decline in 67% of pediatric patients.
  • Delays in EEG initiation in critically ill neonates and children increase mortality.
  • Seizures can lead to cardiac complications such as bradycardia, asystole, or cardiac arrest.
  • ECG monitoring should be done alongside EEG, especially in high-risk patients.

Critical Value Protocols in ICU & EMU (Continuous EEG Monitoring)

  • Alert the Neurologist if a first-ever seizure is detected.
  • Alert the Neurologist if a seizure lasts more than 5 minutes.
  • Alert the Neurologist if a new seizure type appears.
  • Alert the Neurologist if multiple seizures occur within an hour.
  • Alert the Neurologist if there is a risk of physical harm

Critical Value Protocols in In-Home AEEG

  • Notify in-home companion or physician if a seizure exceeds protocol threshold.
  • Notify in-home companion or physician if there is excessive seizure frequency.
  • Notify in-home companion or physician if there is a risk of physical injury.
  • Possible actions for In-Home AEEG include calling 911, visiting the ER, or observing.

Policy Development Recommendations

  • Define what qualifies as a critical value
  • Clarify responsibilities of techs and physicians
  • Standardize communication methods, such as phone and EMR
  • Set timeframes for detection to notification
  • Monitor compliance and effectiveness
  • Failure to act on EEG critical values can cause permanent injury or death, leading to malpractice cases.
  • Hospitals can be held liable for poor monitoring or communication delays related to EEG critical values.
  • A settlement of $4 million was awarded for failure to treat status epilepticus.
  • A patient died during unattended EEG monitoring in another case.

Key Takeaways

  • EEG critical values are life-saving alerts, not optional.
  • Techs and neurologists must act quickly and escalate findings.
  • Cardiac monitoring is essential, especially during seizures.
  • Clear protocols prevent medical errors and save lives.

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