Emergency Treatment Algorithm for Convulsive Status Epilepticus

1. ABCDEFG (ABC's and Don't Ever Forget the Glucose)

2. Airway: lateral decubitus, nasal trumpets, 02, suction

3. IV access

4. Concurrently search for reversible cause



First-line agents:

 - Lorazepam 0.1 mg/kg IV, max 4 mg, repeat once in 4 min or

 - Midazolam 10 mg IM once



Second-line agents:

 - Levetiracetam 60 mg/kg IV (max 4500 mg) or

 - Fosphenytoin or Phenytoin 20 mg/kg IV (max 1500 mg) or

 - Valproate 40 mg/kg IV (3000 mg)



Refractory medications in status epilepticus:

 - Propofol: 2-5 mg/kg IV, then infusion of 2-10 mg/kg/hr

 - Midazolam: 0.2 mg/kg IV, then infusion of 0.05-2 mg/kg/hr

 - Ketamine: 0.5-3 mg/kg IV, then infusion of 0.3-4 mg/kg/hr

 - Lacosamide: over 15 min, then 200 mg q12h PO/IV

 - Phenobaribital: 15-20 mg/kg IV at 50-75 mg/min

 - Consider consulting anesthesia for inhaled anesthetics



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