Status Epilepticus

Status Epilepticus is defined as a seizure lasting > 5 mins or 2+ seizures without full recovery in between.

Management

In the first 5 mins - A-E approach:

• Secure airway

• High-flow O2 if hypoxic

• Check glucose!

• IV access

If still seizing at 5 mins:

• If IV access – IV Lorazepam 0.1mg/kg (Max 4mg)

• If no IV access – Buccal Midazolam or Rectal Diazepam 0.5mg/kg (Max 20mg)

If still seizing after another 10 mins (15 mins overall):

• Repeat Lorazepam and call for senior support

If still seizing after another 10 mins (25 mins overall):

• Find out if pt is on Phenytoin

  • No – IV Phenytoin 20mg/kg infusion over 20 mins OR Levetiracetam 30mg/kg

  • Yes – IV Phenobarbitone 20mg/kg infusion over 5 mins OR Levetiracetam 30mg/kg

If the patient still remains refractory, consider intubation and ICU admission if needed. May require rapid sequence induction with IV Thiopental 4-8mg/kg to put the patient into a medical coma.