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



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