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Status Epilepticus Clinical Pathway — ED and ICU

Clinical Pathway for Evaluation/Treatment of
Infants and Children with Status Epilepticus

 
 

Team Assessment

  • ABCDE, IV Access, neurologic assessment, oxygen, CR monitor
  • POC Glucose
  • Labs as indicated
  • Review maintenance anti-seizure medication (ASM) regimen
 
 
Seizure continues 3–5 min
1st Benzodiazepine 5-10 min
Administer 1st Benzodiazepine
Lorazepam 0.1 mg/kg IV, Max 4 mg
No IV: Midazolam 0.3 mg/kg IN (or buccal), Max 10 mg
 
 
Seizure continues 3–5 min
Administer 2nd Benzodiazepine
Lorazepam 0.1 mg/kg, Max 4 mg
 
 
Seizure continues 3–5 min
1st ASM 10–20 min
Administer 1st ASM
Levetiracetam 60 mg/kg IV, Max 4500 mg
  • Maintenance Levetiracetam > 80 mg/kg/day
    • 1st ASM fosphenytoin 20 mg PE/kg IV, Max 1500 mg PE
    • 2nd ASM valproate 40 mg/kg, Max 3,000 mg
    • POLG: Valproate contraindicated
 
 
Seizure continues > 10 min
2nd ASM 20–30 min
Administer 2nd ASM
Fosphenytoin 20 mg PE/kg IV, Max 1500 mg PE
Age < 1 mo: Consider phenobarbital 20 mg/kg IV, Max 2000 mg
 
 
Seizure continues > 10 min
  • Consult Neurology, recommends 3rd ASM
  • Notify PICU, Tier as indicated
  • Assess need for advanced airway
  • Review differential diagnosis, treat underlying cause
 
 
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