Status Epilepticus (1*)

Question 1

What is it defined as?

Answer 1

Seizure lasting > 5 mins or 2+ seizures without full recovery in between

Question 2

Management Guideline:
What should be done in the first 5 mins of the seizure?

What’s the next step if the seizure hasn’t resolved at 5 mins (now SE)?

What should then be done if the pt is still seizing after another 10 mins (15 mins)?

What should then be done if the pt is still seizing after another 10 mins (25 mins)?

What is the last step if the pt remains refractory?

Answer 2

➊ A-E approach:
• Secure airway
• High-flow O2
• Check glucose!
• IV access

➋ • If IV access – IV Lorazepam 0.1mg/kg (Max 4mg)
• If no IV access – Buccal Midazolam or Rectal Diazepam 0.5mg/kg (Max 20mg)

➌ Repeat Lorazepam and call for senior support

➍ 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

➎ Consider intubation and ICU admission if needed – Rapid sequence induction with IV Thiopental 4-8mg/kg to put pt into a medical coma