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