Status Epilepticus

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)