Management Algorithm for Status Epilepticus • Assess airway, breathing, and circulation • Pulse oximetry • Electrocardiogram • Finger stick (give IV dextrose if glucose < 60 mg/dL) • Aspiration precautions (lateral decubitus) First-line therapy: o Diazepam 5 mg up to a max of 20 mg o Lorazepam 2 mg up to a max of 10 mg o Midazolam 10 mg IV/lM/intranasal Second-line therapy: • Phenytoin 20 mg/kg IV at a maximum rate of 50 mg/min (may give additional 5-10 mg/kg) or • Fosphenytoin 20 PE/kg IM or IV at 150 mg/min (can give additional 5 PE/kg) or • Valproic acid 20-40 mg/kg at 3-6 mg/kg/min or • Levetiracetam 1000-3000 mg over 15 min Third-line therapy: • Intubation and electroencephalogram recommended • Pentobarbital 5 mg/kg IV at 1-5 mg/kg/hr, then 0.5-3.0-mg/kg/hr infusion as needed or • Phenobarbital 20 mg/kg IV at 50-75 mg/min or • Midazolam 0.2 mg/kg IV, then 0.1-0.4 mg/kg/hr or • Propofol 2 mg/kg IV at 2-5 mg/kg/hr, then 5-10 mg/kg/hr as needed #StatusEpilepticus #Management #Algorithm #Neurology #pharmacology #dosing #seizure
