Status Epilepticus

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

Management Guideline:

In the first 5 mins of any seizure, an A-E approach should always be taken:

• Secure airway

• High-flow O2

• Check glucose!

• IV access

N.B. ABCDENFG = ABCDE + Never Forget Glucose!

If seizure hasn’t resolved at 5 mins (now SE):

• 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 the patient is still seizing after another 10 mins (Total = 15 mins):

• Repeat benzodiazepine dose and call for senior support

N.B. Maximum 2 doses of benzodiazepines can be given during an episode!

If the patient is still seizing after another 10 mins (Total = 25 mins):

• Find out if they're 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 remains refractory despite all the measures taken so far, then call anaesthetics for intubation and rapid sequence induction with IV Thiopental 4-8mg/kg (puts the patient into a medical coma).