Status Epilepticus

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Introduction

• Simple seizure
  • Seizure ends in <5 minutes AND
  • Patient wakes up before next seizure
    • No meds required
• Status epilepticus
  • Seizure lasts >5 minutes OR
  • Patient has a 2nd seizure before waking up from 1st
    • Initiate status epilepticus pathway

Approach to Status Epilepticus

• Step 1: Give a benzodiazepine
  • Lorazepam (IV)
  • Diazepam (IV or PR)
  • Midazolam (IV or IM)
• Step 2: Give an anti epileptic
  • Levetiracetam (Keppra)
  • Fosphenytoin
  • Valproic Acid
• Step 3: Continue attempting agents for 30 minutes
  • If seizure continues, you must move onto step 4…
• Step 4: Sedate and intubate the patient
  • Propofol
  • Phenobarbital
• Step 5: Start patient on continuous EEG
  • Detects non-convulsive status epilepticus
  • Usually started once patient is in ICU

Additional Reading

• Round 9 – Seizure (EM Clerkship)
• Emergency Management of Status Epilepticus (EM Cases)