| Adult Generalized Convulsive Status Epilepticus Guidelines | ||
| Access and control airway, vital signs, pulse-oximetry & oxygen (100% NRB) | ||
| Perform blood & fingerstick glucose, serum electrolytes, Ca, Mg, drug level | ||
| Administer thaimine (100mg) then glucose (50ml of 50% dextrose) | ||
| Pregnancy | Toxicologic Seizures | |
| Women in 2nd half of 2nd trimester, | If drug of toxin-induced seizures are possible, one should consider these causes of seizures which may require additional therapeutic modalities: | |
| 3rd trimester or 1 week post-partum | carbon monoxide hyperbaic therapy | |
| administer 4 grams magnesium sulfate | cocaine high doses of benzodiazepines | |
| followed by 2 g/hr and consult OB/GYN | cyanide cyanide antidote kit | |
| cyclic antidepressants bicarbonate therapy | ||
| isoniazid pyridoxine therapy | ||
| lithium hydration and hemodialysis | ||
| organophosphates atropine and 2-PAM | ||
| theophylline charcoal hemoperfusion | ||
| Start anticonvulsant therapy | ||
| 1. Lorazepam 0.1mg/kg (maximum rate of 2mg/min) | ||
| (1:1 dilution in D5W or NS) | ||
| If no response after 5 minutes, repeat X 2 doses | ||
| If seizures continue: | ||
| 2. Fosphenytoin 20mg/kg PE IV loading dose (rate not to exceed 150mg/min PE) | ||
| (dilute in D5W or NS to provide 1.5-25mg PE/ml) | ||
| If no response after 30 minutes, repeat fosphenytoin 5-10mg/kg PE IV | ||
| If seizures continue: | ||
| Patient requires intubation | Patient requires intubation | Special Circumstances |
| (ex. non ICU patients, DNI) | ||
| Midazolam 0.2mg/kg bolus, followed by 0.75-10mcg/kg/min | Phenobarbital* 10-20mg/kg IV (rate not to exceed 100mg/min or 60mg/min IV push) | |
| OR | (dilute in 100-150ml of D5W or NS) | Valproic acid* 15-20mg/kg IV to be infused not greater than 3mg/kg/min |
| Propofol 1-2mg/kg IV, followed by 2-10mg/kg/hr IV | (dilute in D5W or NS to a maximum concentration of 4mg/ml) | |
| OR | ||
| Pentobarbital 10-15mg/kg IV over 1 hour, followed by 0.5-1mg/kg/hr | ||
| EEG Monitoring Recommended | ||
| * Check antileptic drug serum concentration 1-2 hours post loading dose. Once seizures are controlled, start maintenance therapy. Closely monitor blood pressure, respiratory rate, and cardiac rhythm | ||
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