Status Epilepticus


  • Simple seizure
    • Seizure ends in <5 minutes AND
    • Patient wakes up before next seizure
      • No meds required
  • Status epilepticus
    • Seizure lasts >5 minutes OR
    • Patient has a 2nd seizure before waking up from 1st
      • Initiate status epilepticus pathway

Approach to Status Epilepticus

  • Step 1: Give a benzodiazepine
    • Lorazepam (IV)
    • Diazepam (IV or PR)
    • Midazolam (IV or IM)
  • Step 2: Give an anti epileptic
    • Levetiracetam (Keppra)
    • Fosphenytoin
    • Valproic Acid
  • Step 3: Continue attempting agents for 30 minutes
    • If seizure continues, you must move onto step 4…
  • Step 4: Sedate and intubate the patient
    • Propofol
    • Phenobarbital
  • Step 5: Start patient on continuous EEG
    • Detects non-convulsive status epilepticus
    • Usually started once patient is in ICU

Additional Reading

1 Comment

  1. Neil

    Hi Zack,

    First time poster, long-time listener. Wanted to ask about the timing. Do you start the 30 minute countdown when the seizure initially occurred outside of the hospital or when they are in your care? Thanks! Love your podcasts

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