Neuro
Status Epilepticus Algorithm
Benzodiazepine, second-line drug, then anesthesia
1 0–5 minutes: stabilize
- Seizure lasting 5 minutes or more, or repeated seizures without recovery
- Airway, oxygen, monitor, IV access; time the seizure
- Fingerstick glucose: under 60 mg/dL, give thiamine 100 mg then dextrose
2 5–20 minutes: benzodiazepine
3 20–40 minutes: second-line drug
- Levetiracetam 60 mg/kg (max 4,500 mg), or
- Fosphenytoin 20 mg PE/kg (max 1,500 mg PE), or
- Valproate 40 mg/kg (max 3,000 mg)
- The three worked equally well in ESETT; choose by comorbidity
4 After the seizure stops
- Not waking within 10–20 minutes: EEG for nonconvulsive status
- Look for the cause: glucose, sodium, calcium, magnesium, drugs, withdrawal, infection, stroke, tumor
- CT head; LP if infection is possible
5 40+ minutes: refractory status
- Intubate
- Continuous midazolam, propofol or ketamine infusion
- Continuous EEG to target seizure suppression
- Neurology consult; search for the cause
Drugs in this algorithm
Related one-pagers
- Pediatric Assessment and EmergenciesDKA, cerebral edema and status epilepticus: Treat convulsive status epilepticus at 5 minutes (ILAE 2015) with a full weight-based benzodiazepine dose, repeat it once, then move to a second-line drug (AES 2016); underdosing and delay are the usual errors. Check glucose at once.
- Pharmacology by Class and SuffixAntidotes and reversal: matching drug to rescue: Naloxone and flumazenil are competitive antagonists, so the original drug can outlast them: keep monitoring and redose as ordered. Flumazenil can precipitate seizures and is not used when a benzodiazepine was given for a life-threatening problem such as status epilepticus (lorazepam label). Glucagon bypasses the β receptor in β-blocker poisoning, di
- Physiological Adaptation: Conditions at a GlanceNeuro and spinal cord: Status epilepticus: Seizure lasting 5 min or more, or back-to-back without waking: Side-lying, oxygen, glucose check, benzodiazepine as ordered (IM if no IV): At 5 min, at once
More neuro algorithms
Practice free in your browser2,150+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
For education and exam preparation only. Follow your institution’s protocols. Study aid with typical adult values; follow your institution's protocols and current AHA guidelines.