Seizures & Status Epilepticus*

WHAT IS STATUS TREATMENT TO INITIATE

EPILEPTICUS? LINE BURST
1st LINE OPTIONS 3rd SUPPRESSION
Abnormal 2nd INFUSIONS
electrical Midazolam Pentobarbital
impulses Lorazepam Levetiracetam
20-60 mg/kg IV 0.2 mg/kg load 5 mg/kg load
4-8 mg IV 0.2-2.9 mg/kg/hr 1-5 mg/kg/hr
or (4500 mg max)
Continuous Airway or
(Consider Nasal) Diazepam or Propofol
seizure for >5 min 5-10 mg IV
or >2 in 5 min Valproate 1-2 mg/kg load
or 20-80 mcg/kg/min
without return Supplemental 30-40 mg/kg IV
Midazolam (3000 mg max) or
to consciousness Oxygen
5-10 mg IV or IM
or Ketamine
1-2 mg/kg load
May repeat x 1
TYPES Fosphenytoin 2-7 mg/kg/hr
after 5 min
20 mg PE/kg IV
Convulsive
INTUBATE
• May involve jerking
motions, grunting sounds,
drooling, and rapid eye ONSET 5 MIN 10 MIN 30 MIN 90 MIN
movements
• More likely to lead to
long-term injury DIAGNOSTIC WORKUP
Fingerstick Secure IV ASSESS FOR REVERSIBLE CAUSES CONTINUOUS EEG
Nonconvulsive Glucose Access • Eclampsia
• May appear acutely
• Infectious
confused or look like
• If <60 mg/dl, give • Electrolyte disturbances
they're daydreaming
100 mg thiamine IV and (sodium, calcium, magnesium)
• May have difficulty
then 50 ml D50W IV • Imaging for structural cause
speaking
(CT head, CTA head and neck)

*For educational purposes only. Not meant to substitute for medical judgment. © 2022 American College of Chest Physicians