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 • Levebracetam 60 mg/kg IV (max 4,500 mg) or • Fosphenytoin or Phenytoin 20 mg/kg IV (max 1 ,500 mg) or • Valproate 40 mg/kg IV (3,000 mg) ADVANCED AIRWAY MANAGEMENT • RSI Preoxygenation: BVM • Induction: propofol or "ketofol' • Paralytics: Rocuronium if Suggamadex is available or seizure duration > 25m min; otherwise succinylcholine REFRACTORY MEDICATION 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: 400 mg IV 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 #Status #Epilepticus #Treatment #Algorithm #Convulsive #management #neurology #seizures #ACEP
