Status Epilepticus

We had a great noon rounds session today on status epilepticus. A pharmacological management strategy (taken from that paper) is shown in the figure below:



You should note that a later publication suggests that initially patients should treated with IV lorazepam and phenytoin up-front and then if seizures continue after 10 minutes they suggest you should move on to anesthesia and intubation citing a low response rate to second line agents (e.g. phenytoin, phenobarbitol, repeat lorazepam).

Also remember:

1) Secure the airway if required, give oxygen, and obtain IV access
2) Thiamine +D50 if any chance seizure is hypoglycemic in origin
3) Treatment of hyperthermia (T>40) with active cooling
4) Search for cause of seizure as appropriate.