ED Pathway for Evaluation/Treatment of Children
with Status Epilepticus
0-5 min
Consider Etiology Further Diagnostic Testing
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Triage - Critical
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  • MD/RN Rapid Assessment
  • ABCDE, Oxygen, Monitors
  • IV access, Glucose
  • Brief H&P
  • Laboratory Studies
  • Immediate MD/CRNP Orders
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IMMEDIATE THERAPY TO
STOP SEIZURE

ANTICIPATE NEED FOR
NEXT MEDICATION

5-10 min
1st Agent
Lorazepam 0.1 mg/kg
(max 4mg)
Reassess in 5 minutes
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Lorazepam 0.1 mg/kg
(max 2 mg)
Proceed immediately
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10 min
2nd Agent
Phenytoin* 25 mg/kg
Reassess in 10 minutes
Notify Neurology, PICU
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35 min
3rd Agent
Choose One of the Following
  • Phenobarbital
  • Valproate
  • Levetiracetam
See Medications for Status
Epilepticus
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Transfer to PICU
  *Adjust dose as needed for patients who are maintained on Phenytoin
Posted: November 2008
Revised: October 2011, August 2011
Authors: J. Fein, MD, J. Baren, MD, N. Abend, MD, D. Dlugos, MD, J. Lavelle, MD, H. Monk, PharmD