Status Epilepticus
General measures:
Oxygen
Establish IV access in large veins
Take blood for electrolytes, glucose, calcium & anti-epileptic drug levels.
Specific drug therapy:-
Inj Lorazepam 2-4 mg or
Inj Midazolam 4-10 mg or
Inj Leviteracitam 500 - 1000 mg or
Inj Diazepam 5 -10 mg IV , repeat if necessary.
Step 2:
10 minutes. If seizures continue Phenytoin 15-18 mg/kg diluted to 10mg/ml in normal saline @50mg/min.
alternative step 2 : in patient receiving adequate phenytoin:
# Inj Phenobarbitone10mg/kg diluted 1:10 in water for injection at 100mg/min. Monitor BP and respiration.
# Inj Valproate 20-30 mg/Kg IV over 5-10 min
Step 3: If severe systemic disturbances occur at any stages or if seizures continue:
# Anaesthesia with IV thiopentone and ventilation with EEG monitoring until seizures ceases. Note: - Propofol can be used IV alternatively. Dose: 1-3 mg/Kg bolus over 5 minutes followed by maintenance infusion of 2-4 mm/Hg/hr.
For emergency seizure control Status epilepticus and emergency seizures (home to hospital)
# Midazolam nasal spray (5-10 puffs per nostril)