Seizure Management Algorithm (Status Epilepticus)
Note: This document provides a structured summary of the Seizure Management Algorithm focusing on Status Epilepticus for educational and reference purposes. Status Epilepticus is a medical emergency. It is not a substitute for certified ACLS training and adherence to the latest guidelines published by the American Heart Association (AHA) or other relevant governing bodies. Always consult the most current official guidelines and local protocols.
Continuous seizure activity or recurrent seizures without full recovery of consciousness between seizures, typically lasting $\ge$ 5 minutes.
Ensure safety, position patient, assess ABCs (Airway, Breathing, Circulation). Provide oxygen, monitor vital signs, establish IV access, check blood glucose, obtain initial labs (electrolytes, anticonvulsant levels if applicable), perform brief neurological assessment.
Administer a Benzodiazepine: Lorazepam 0.1 mg/kg IV (max 4 mg), may repeat once. OR Midazolam 10 mg IM/IN/Buccal (if no IV access), may repeat once. OR Diazepam 0.15-0.2 mg/kg IV (max 10 mg), may repeat once.
Is the seizure activity ongoing after appropriate administration of the first-line benzodiazepine?
Administer a second-line agent: Fosphenytoin 20 mg PE/kg IV (max 1500 mg PE) OR Levetiracetam 20-60 mg/kg IV (max 4500 mg) OR Valproate 20-40 mg/kg IV (max 3000 mg).
Is the seizure activity ongoing after appropriate administration of the second-line agent?
Administer a third-line agent: Midazolam infusion, Propofol infusion, or Phenobarbital IV. Consider continuous EEG monitoring. Consult Neurology/Critical Care.
Proceed to Identify and Treat Precipitating Causes and Ongoing Management.
Proceed to Identify and Treat Precipitating Causes and Ongoing Management.
Look for underlying causes: metabolic abnormalities (hypoglycemia, hyponatremia), infection (meningitis, encephalitis), structural brain injury (stroke, tumor, trauma), drug/alcohol withdrawal, eclampsia, hypoxia.
Continuous vital sign and neurological monitoring. Airway management as needed. Continuous EEG monitoring (especially for refractory SE). Prevent recurrence, manage complications, long-term anticonvulsant therapy.
