What is Holden's favorite word?

Hold on, Holden! | Quizalize

Write questions based on the text: How long could you survive at sea? One day? Two? And when would you start to lose hope? When Robert Hewitt came to the surface, he realized straight away that something was wrong. He’d been diving for sea urchins and crayfish off the coast of New Zealand with a friend, and had decided to make the 200-metre swim back to shore alone. But instead, strong underwater currents had taken him more than half a kilometre out to sea. Lying on his back in the middle of the ocean, Robert told himself not to panic. He was a strong swimmer and he was wearing his thick wetsuit. 'I'm not going to die. Someone will come,' he told himself. But three hours passed and still no one had come for him. Robert would soon have to make a tough decision. He was now a long way from the coast and the tide was taking him further out, but he decided not to try to swim for shore. He felt it was better to save his energy and hold on to his brightly coloured equipment. But the decision was not an easy one. 'l just closed my eyes and said, "You've made the right decision. You've made the right decision" until that's all I heard,' he remembers. As night approached, Robert established a pattern to help him survive in the water. To stay warm, he kept himself moving and took short naps of less than a minute at a time. Every few hours, he called out to his loved ones: 'Just yelling out their names would pick me up and then I would keep going for the next hour and the next hour and the next.' When he woke the next morning, he couldn't believe he was still alive. Using his bright equipment, he tried to signal to planes that flew overhead. But as each plane turned away, his spirits dropped. He managed to drink water from his oxygen tank to keep himself alive, but as day turned to night again he started to imagine things. Robert woke on the third day to a beautiful blue sky. Now seven kilometres off the coast, Robert decided he had to swim for it. But the sun was so strong and Robert quickly ran out of strength. Hope turned to disappointment yet again: 'l felt disappointed in myself. I thought I was a lot fitter. I thought I would be able to do it.' Robert then started to think he might not survive. On the fourth day, the lack of food and water was really starting to affect him. Half unconscious, and with strange visions going through his head, he thought he saw a boat coming towards him with two of his friends in. Another vision, surely. But no - 'They put me in the boat and I said something like "Oh, how's it going, what are you guys doing here?"' Then he asked them the question that he'd asked in all his visions: 'Can I have some water?' As they handed him the water and he felt it touch his lips, he knew. This was not a vision. He'd been found! After four days and three nights alone at sea, Robert had been found! Sunburnt, hungry and exhausted, but alive.

1. What is the Earth's thickest layer? A) Crust C) Outer core B) Mantle D) Inner core 2. What is the condition required for a typhoon to form? A) High vertical wind shear C) Presence of a pre-existing disturbance B) Low sea surface temperatures D) Thick mantle layer 3. A liquid layer that surrounds the inner core. Made up of iron and nickel. A) Outer Core C) Upper Mantle B) Lower Mantle D) Lower Mantle 4. What is the name for a fold that is curved upwards? A) Syncline C) Anticline B) Monocline D) None of the above 5. What is the point on the Earth's surface directly above the focus of an earthquake? A) Seismograph C) Epicenter B) Seismogram D) Focus 6. Which seismic waves can travel through solids, liquids, and gases? A) P waves C) Love waves B) S waves D) Rayleigh waves 7. What term describes the calm center of a typhoon? A) Eyewall C) Tropical storm B) Super typhoon D) Eye 8. What is the Philippine government agency responsible for monitoring and forecasting tropical cyclones? A) PAGASA C) PAR B) PSWS D) NOAA 9. Approximately how many typhoons can enter the Philippine Area of Responsibility per year? A) 10 C) 30 B) 20 D) 40 10. What is the best way to do during an earthquake? A. I will run outside to get away from the shaking. B. I will stay indoors and take cover under a sturdy table or desk. C. I will get under a doorway or in a corner. D. I will stay in my bed and hold on to the headboard.

According to 〜によれば add to 増やす add up 合計する after a while しばらくして against the idea その考えに反対して all of a sudden 突然に all the time いつも all through the night 一晩中 along with 〜と一緒に apply for 〜に申し込む apply to 〜に適用する as a rule 原則として aside from 〜のほかに / 〜を除いて at any cost どんな犠牲を払っても at heart 心の底では at last ついに at least 少なくとも at length 詳細に at most 多くても at once すぐに / 一度に at the sight of 〜を見て at times 時々 attach to 〜に付ける / 〜に結びつける back up 支援する、バックアップする based on 〜に基づいて be absent from 〜を欠席している be against 反対する be based on 〜に基づいている be confident of 〜に自信がある be curious about 〜に好奇心を持つ be derived from 〜に由来する be filled with 〜で満たされている be full of 〜でいっぱいである be made up of 〜で構成されている be pleased with 〜に満足している be short of 不足している be similar to 〜に似ている because of 〜のせいで / 〜のおかげで before long まもなく break out 突発する break out in （急に）〜になる break up 解散する / 別れる bring out 引き出す / 公表する bring up 育てる / 持ち出す burst into 急に〜し始める by heart 暗記して by mistake 間違えて by now 今頃までには by the way ところで by way of 〜を通じて call for 要求する / 呼びかける call out 大声で呼ぶ carry on 続ける carry out 実行する、行う catch up with 〜に追いつく close to 〜に近い come across 偶然出会う / 見つける come into 〜に入る / 〜になる come out 出てくる / 公表される come up with 〜を思いつく compared with 〜と比べて depend on 〜に依存する do him good 彼に利益をもたらす drive at 意図する、狙う drop by 立ち寄る drop down 落ちる feel at home くつろぐ feel like doing 〜したい気分 feel sorry 気の毒に思う figure out 理解する find fault with 〜に文句をつける find out 知る、解明する for fear of 〜を恐れて for free 無料で for good 永遠に、完全に for once 一度だけ / 今回だけは for sale 売り物の for the best 最善のために get over 乗り越える get ready 準備する get rid of 〜を取り除く give away 与える、寄付する give in to 〜に屈する give off 放つ give out 配る / 発表する go ahead 続けて行う go down 下がる / 沈む hand in 提出する hand over 手渡す hang on 待つ / 頑張る hang up 受話器を置く hear from 〜から連絡をもらう help yourself 自由に取る / 自由にどうぞ hold back 控える hold on 待つ / 持ちこたえる hold up 停止させる、遅らせる in a jacket ジャケットを着て in a word 一言で言えば in advance 前もって in case 〜の場合に in common 共通して in detail 詳細に in hand 手元に in part 部分的に in place of 〜の代わりに in return 見返りに in terms of 〜の観点から in the distance 遠くに in the habit of 〜する習慣がある in the way 妨げになって instead of 〜の代わりに keep a secret 秘密を守る keep an eye on 見守る keep away from 近づかないようにする keep on Ving 〜し続ける keep pace with 〜に遅れずについていく keep the change お釣りはいりません keep track of 記録をつける / 追跡する keep up with 〜に遅れずについていく lay it down それを置く / 規定する less than 〜未満 / 〜より少ない look after 世話をする look back on 〜を振り返る look down on 〜を見下す look like 〜のように見える look up 調べる / 見上げる made up of 〜で構成されている major in 〜を専攻する make efforts 努力する make it out 理解する / 成し遂げる make out 見分ける、うまくいく make progress 進歩する make sense 理解できる、意味を成す make up your mind 決心する mind your own business 自分のことに集中しろ move on 次に進む no longer もはや〜ない not always 必ずしも〜でない nothing but ただ〜だけ on air 放送中 on behalf of 〜を代表して on business 仕事で on fire 火がついている on purpose わざと on the point 〜の点で on time 時間通りに one another お互いに out of the question 問題外で pass by 通り過ぎる pay attention 注意を払う play a part in 〜で役割を果たす pour out 注ぎ出す、溢れ出る prefer A to B BよりAを好む put away 片付ける put off 延期する put on 着る / 演じる　(weightで太る） put out 消す / 発表する reach for 手を伸ばす rely on 〜に頼る result in 【自動詞】結果として〜になる run it over それをひく / 読み返す run out of 〜を使い果たす run over ひいてしまう、走り回る see about 手配する / 調べる see off 見送る see through 見抜く / 見通す set out 出発する、始める set up 設置する / 設定する show off 自慢する、見せびらかす show up 現れる / 到着する sit up 座る、起き上がる speak up はっきり話す stand out 目立つ stand out 目立つ stand up for 〜を支持する suffer from 〜に苦しむ take away 持ち去る / 奪う take in 理解する、取り入れる take notice of 注意を払う take on 引き受ける / 挑む take out 取り出す / 持ち帰る take over 引き継ぐ、乗っ取る take part 参加する take place 起こる / 開催される take risks 危険を冒す take turns 交代で行う talk over 相談する tear off 引き裂く the second largest 二番目に大きい think better of 考え直す throw away 捨てる try on 試着する turn in 提出する turn off 消す / 切る turn on （スイッチを）入れる turn out 結果的に〜になる turn over ひっくり返す under control 制御下にある up to date 最新の with ease 容易に with regard to 〜に関して

THE BATTLE OF THE PHILIPPINE SEA Occured in the Philippine Sea and Marinas The battle engaged the bulk of thepagan American forces, and prevented the Japanese from reinforcing, their fleet in the •Marianas. •A month after, the Japanese LOST THEIR 4 best aircraft carriers in the Battle of Midway, an island northwest of Pearl "Harbor. 1. The Batle of the Philipine Sea lasted just one day June 19- June 20 1944 3. is also called the "Marianas Turkey Shoot” The Battle of the Coral Sea The Coral Sea is Between New Guinea and Australia The Japanese Were Trying to Attack Australia! The U.S. Navy and the Japanese Navy Fought! Nobody Won! U.S. Was Able to STOP the Attack on Australia! (Victory!) The American fleet defeated the Japanese. American planes bombarded Japanese installation in Manila from the air. Air strikes were also carried out in the Visayas. Battle of Okinawa: Battle Details The attack on Okinawa took heavy toll on both sides of the fighting... The Americans lost 7,373 men killed and 32,056 wounded on land. At sea, the Americans lost 5,000 killed and 4,600 wounded. The Japanese lost 107,000 killed and 7,400 men taken prisoner. The Japanese may have lost another 20,000 dead as a result of American tactics whereby Japanese troops were incinerated where they fought. The Americans also lost 36 ships. 368 ships were also damaged. 763 aircraft were destroyed. The Japanese lost 16 ships sunk and over 4,000 aircraft were lost. battle facts -the japanese launched fierce kamikaze attacks l-arge amouunts of civillian deaths -japanese soldiers using civilians as human shields Americans ended with more triumphs in the battles like in: General MacArthur and the Allies next turned to the Island of Iwo Jima The island was critical to the Allies as a base for an attack on Japan It was called the most heavily defended spot on earth Allied and Japanese forces suffered heavy casualties IWO JIMA American soldiers plant the flag ol the Island of Iwo Jima after their victory Battle of Leyte Gulf "Second Battle of the Philippine Sea". Time: October 23 - 26, 1944 during WW. Location: Leyte Gulf in Philippines (East coast), Philippine islands of Leyte, Samar, and Luzon. Largest naval battle in WWII. Leyte was secured and was liberated from the hands of the Japanese Americans decided to launch their attack in Leyte since the weak side of the Japanese fleet was in Visayas. Heavy bombing at the Leyte beaches cleared the way for the landing in Palo, Leyte. Leading the American troops were General Douglas MacArthur and President Osmeña, who took over after the death of President Quezon in Saranak Lake in New York. the battle for the liberation of manila The commonwealth government capital was transferred from tacloban to Manila. Manila once again became the seat of the national leadership. ON july 4, 1945, general macarthur announced the total liberation of the Philippines • The Commonwealth government capital was transferred from Tacloban to Manila. Manila once again became the seat of the national leadership. On July 4, 1945, General MacArthur announced the total liberation of the Philippines. Americans surprised the Japanese with the landing of troops in Lingayen Gulf in Pangasinan. • The Filipino guerillas had already cleared the area and neutralized many of the Japanese forces. The first target was the UST, which was used by the Japanese as a camp for civilian prisoners of war, and they were able to free them. • More than 1000 POWs from Bataan and Corregidor were also freed from the Bilibid Prisons. • The battle of Manila was recorded as the fiercest urban fighting in the entire Pacific War. WATERLOO DAILY COURIER-NEWSPAPER “PEACE! WAR ENDS; JAPANESE ACCEPT ALLIED TERMS. ON EMPEROR" On August 6, due to persistent refusal of Japan to yield, another atomic bomb was dropped in the shipbuilding city of Nagasaki. On August 15, V-J Day (Victory in Japan), Emperor Hirohito finally admitted defeat and on September 3, 1945 the document of surrender was signed on board of the U.S. battleship Missouri in Tokyo Bay. With the liberation of the Philippines, the Americar troops moved on to finally end the war in Asia. The Japanese cities of Tokyo, Osaka, Nagoya and Kure were bombed. In July 26, the allies demanded surrender but the Japanese continued to hold on to their belief that surrender is a dishonor. Atomic bomb was dropped on the populous city of Hiroshima, 60% of the city was destroyed. It was estimated that there were more than 80 000 people died on the spot and more than 37 000 suffered severe injuries. Today, the HIROSHIMA SHRINE serves as a reminder of th horrors of war and the need to preserve PEACE in the world. THE POSTWAR PHILIPPINE COMMONWEALTH-• Philippine Commonwealth resumed. Osmeña was confronted with a war - ravaged country with no financial resources for PROBLEMS • Poverty • Destruction of Properties • Unemployment • Price Increase • Hoarding • Graft and Corruption HINDRANCES -Rehabilitation of INDUSTRIES COULD NOT BE DONE BECAUSE OF LACK OF FUND -RAILWAYS WERE DESTROYED THAT LED TO SLOW PRODUCTION AND TRANSPORTATION SOLUTION -PCAU (Philippine Civil Affairs Unit) was established by MacArthur to provide emergency relief in areas liberated by the Americans. - It organized food distribution centers. CHALLENGES TO INDEPENDENCE • On April 30, 1946, the Philippine the US President. BIASED AGREEMENTS: Rehabilitation or the Tydings Act of 1946, passed by the US Congress, was approved by Commission • This Act created the US Philippine War Damage The Act also provided for the transfer of $100,000,000 surplus property of the United States to the Philippines. The Philippine Armed Forces received large quantities of valuable military equipment and supplies. BIASED AGREEMENTS: • The United States Congress offered $800 million for post World War Il rebuilding funds if the Bell Trade Act was ratified by the Philippine Congress Parity rights granting U.S. citizens and corporations rights to Philippine natural resources equal to (in parity with) those of Philippine citizens The Philippines used to celebrate its Independence Day on July 4, and not June 12, by virtue of the Truman Proclamation in 1946. In the early 1960s, however, the Philippine Historical Association lobbied to bring back June 12 as our Independence Day. In 1962, President Diosdado Macapagal issued a proclamation to make the change official. DECLARATION OF PHILIPPINE INDEPENDENCE • On July 4, 1946, the Americans granted independence to the Philippines.

Quiz on Standard Hold Procedure and Transferring a Call 5-19-23

End up - оканчиваться Pick up - забрать, собрать hold up продержаться give out - перестать работать keep up with - поспевать, угнаться fall behind отставать give up перестать что-то делать focus on- сконцентрироваться run away - убежать freak out нервничать

Why the Sun and Moon Live in the Sky This play is based on an African folktale that tells how the moon and sun ended up in the sky. Characters: Narrator Sun Moon, Sun's Wife Water Narrator: Long ago, Sun, Moon, and Water lived together on Earth. (Sun and Moon are eating breakfast at home.) Sun: I will visit my good friend Water today. Moon: That sounds enjoyable, but why doesn't Water ever visit us? Do you feel ashamed or embarrassed to invite Water here? Sun: No, I am proud of our house. I will invite Water today! (Sun visits Water at the beach.) Sun: Water, why don't you ever visit us? Water: Your house can't hold me and my family. Sun: That's nonsense! Moon and I will enlarge our house, so there will be plenty of room for everyone! Water: Then I will visit you. Sun: Wonderful! Please holler loudly, so I hear you when you arrive. Now I must dash home quickly to start the work. (Sun rushes home.) Narrator: Sun and Moon raced to make their home larger. They added rooms and raised the roof higher. The new house was completely different and had no similarities to their old home. They felt it was a victory, or a win, for now their friend could visit. Water: Sun and Moon, I have arrived! Sun: Isn't this the largest home you've seen? Moon: Sun, it's not polite to brag, so please don't boast to our guest. Water, come inside. Narrator: Water splashed through the door carrying colorful fish, frogs, and crabs. As the water began to rise, Sun and Moon climbed onto furniture. Then they scrambled onto the roof. Sun: Moon, I'm not sure about the wisdom of inviting Water. Perhaps this wasn't a smart idea! Moon: No, Sun, it was the right thing to do but we must fly to safety! Narrator: Sun and Moon flew to the sky, where they remain today and still shine down on Water.

[t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ • It is the commonest cause. no cause can be detected ( 65 % ) • It may be associated with positive family history in some cases. • It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: • Somatic: • Psychic: • Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: • Somatic: • Psychic: • Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: • High frequency ( 50 attacks / day). • Falling to the ground without warning. • Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. • The jerks are bilateral contractions, mainly of the shoulders and arms. • However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly • Simple: • As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: • Focal fits: • Motor jacksonian fits: 2. General Sensory fits: • Focal fits: • Sensory jacksonian fits: 3. Special Senso1y fits: • Visual hallucinations: • Auditory hallucinations: • Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY • Usually: • The cause: • Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. • It is associated with: • EEG: • It is not associated with: normal. • Missed ttt. • Menses. • Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. • Alcohol use & Drug abuse ( e.g. cocaine ). • S timulation by photons & Hyperventilation. • S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: • It is the most specific test for epilepsy because it records the electrical activity of the brain. • It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" • To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" • To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: • The patient stays free of symptoms for at least 2 years. • The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " • Place the patient on the ground, to guard against falling from bed. • Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). • Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.

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