Status Epilepticus Algo v1

Ongoing seizure > 5 minutes
Recurrent seizures without return to baseline mental status
  • Seizure
    • Therapeutics
      • Lorazepam 0.1 mg/kg IV/IM
      • Midazolam 0.1 mg/kg IV/IM
      • Midazolam 0.2 mg/kg IN
      • Diazepam 0.5 mg/kg PR
    • Diagnostics
      • Correct personnel (RT/Nursing/Pharmacy)
      • Glucose
      • IV access
      • Monitor
      • Check airway
  • 5 minutes – Status Epilepticus
    • Therapeutics
      • Repeat benzodiazepine
      • Fosphenytoin 20-30 mg/kg IV (150mg/min)
      • Phenytoin 20-30 mg/kg IV (50mg/min)
    • Diagnostics
      • Evaluate for possible ingestions (INH)
      • CHEM 10, MG, Phos
      • AED Levels
      • CBC
      • LFT
      • PT/PTT
      • UTOX
      • Consider Cultures
      • Consider Head CT
      • Consult Neurology
  • 10 minutes – Initial Refractory SE
    • Therapeutics
      • Keppra 40 mg/kg IV @ 5 mg/kg/min (Max 3 g)
      • Consider valproate 20 mg/kg IV @ 5mg/kg/min (Avoid use in patients with liver disease)
  • 20 minutes – Later Refractory SE
    • Therapeutics
      • Phenobarbital 30 mg/kg IV @ 2 mg/kg/min (max 60 mg/min)
      • Consider empiric Pyridoxine 100 mg IV (if under age 2)
      • Consider empiric glucose and thiamine
    • Diagnostics
      • Prepare to secure airway
      • Admit PICU
      • Consider invasive central venous and arterial lines
      • Arrange continuous EEG
  • 25 minutes – Coma Induction
    • Therapeutics
      • Midazolam 0.2 mg/kg bolus followed by infusion of 0.1 mg /kg/hr (Titrate to seizure resolution to max of 2 mg/kg/hr)
      • Consider general anesthetics or propofol for refractory SE on EEG

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