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 #Convulsive #Status #Epilepticus #Treatment #Algorithm #Management #Neurology #Pharmacology
