Acute Care 33: Status Epilepticus Treatment Plan
Status Epilepticus – Initial Management Algorithm—Age 12 to Adult1-3
| A
– Open and Control Airway-
(Administer O2, suction, and place airway
as needed) B – Breathing – (Assess air exchange, ventilate with BVM, and intubate as needed) C – Circulation – (Vitals= O2 sat, BP, HR, RR, Temp) (ECG Monitor) (IV access) D – Assess Disability (AVPU), Do the DONT |
Benzodiazepines
or
or
or
or
or
|
 |
 |
Focused
History and Physical Exam
|
Laboratory Tests
|
Antiepileptic Drug Therapy Algorithm–Age 12 to Adult
(Use algorithm if patient is actively seizing or has recurrent seizures)
| If seizures continue Second-Line Meds |
|
Phenytoin 18 to 20 mg/kg at
50 mg/min IV or or
Phenobarbital 20 mg/kg IV/IO in toxin-induced seizure |
| Are seizures continuing? |
| If the seizures continue for more than 60 to 90 minutes with the use of above meds or the patient has developed extreme hyperthermia, he or she has refractory seizures |
|
Treatment
of refractory seizures1,3:
*IV midazolam – 0.2 mg/kg slow IV bolus, followed by 0.75 to 10 μg/kg/minute drip- or *IV propofol – 1 to 2 mg/kg IV, followed by 2 to 10 mg/kg/hour or *IV pentobarbitol – 6
to 8 mg/kg IV over 1 hour, followed by |
References
- Leppik IE. Status Epilepticus Treatment in 2001- New Approaches, New Medicines. MINCEP Epilepsy Reports. 2001; Volume X: Number 2.
- Bone RC. Treatment of Convulsive Status Epilepticus. JAMA. 1993;270:854-859.
- Lowenstein, DH. Status Epilepticus. N Engl J Med. 1998;338:970-976.