Status Epilepticus Clinical Pathway — ED, Inpatient and ICU

Immediate Management

Goals

Rapid administration of benzodiazepines (2 doses) and other anti-seizure medications to stop seizures. Support and monitor cardiorespiratory function. Identify acute provoking etiologies.

Obtain IV access. If no IV access > 5 minutes, consider buccal midazolam or use of IO route.
Assess for etiology by H&P, initial labs, imaging.
Evaluate for lateralizing neurologic findings.

Airway	Head positioning for non-invasive airway protection and gas exchange Accessory airways as needed Supplemental oxygen Suction Intubation with RSI as indicated
Monitors	CR Monitor Continuous pulse oximetry Blood pressure Temperature ET CO₂ as indicated
IV Access	2 peripheral IVs as soon as able If no IV access in five minutes or known difficult access, consider: Buccal midazolam or IO access as indicated See Anti-seizure Medications
Lab Test Considerations	POC Glucose CMP, magnesium, phosphate CBC, PT, PTT HCG (urine or serum) Consider urine, serum tox screen Anticonvulsant levels as indicated Blood culture as indicated
Brief History	Seizure History Time started Number of seizures Medications given, time given Prior history of seizures Change in typical seizure pattern Prior neurologic or developmental problems VP Shunt Current medications Recent fever, antibiotics, trauma Concern for ingestion
PE	Medical and neurologic exam, VS Evaluate for neurologic findings
Imaging	Consider non-contrast head CT

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Find a research study

Innovation and your child

Find research studies

Status Epilepticus Clinical Pathway — ED, Inpatient and ICU

Immediate Management

Goals

Find a research study

Innovation and your child

Find research studies

Status Epilepticus — Immediate Management — Clinical Pathway: ED, Inpatient and ICU

Status Epilepticus Clinical Pathway — ED, Inpatient and ICU

Immediate Management

Goals