Status epilepticus

management
Airway
High-flow oxygen
Don’t ever forget glucose

5 After start
Yes (or can
Vascular
min of convulsion
be established
quickly)
access?
No

S
T Midazolam
Midazolam (buccal) 0.5 mg/kg
E 0.1 mg/kg IV or IO
or
Diazapam (rectal) 0.5 mg/kg
P
1

10 After start
Still
No Monitor
min of step 1
fitting?

Yes

S
Midazolam
T 0.1 mg/kg IV or IO
Call for senior help
E Paraldehyde
P Optional 0.8 mL/kg of the 50:50 mixture with oil
Give while preparing or infusing phenytoin

2
Use should not delay phenytoin

Prepare phenytoin No Already on Yes Prepare phenobarbitone

phenytoin?

10
min
After start
Still
fitting?
No Monitor

of step 2

Yes

S Reconfirm it is an epileptic seizure

T
E Not on
phenytoin
Senior help is now needed
Seek anaesthetic / ICU advice
On
phenytoin
P
3
Give phenytoin 20 mg/kg Give phenobarbitone 20 mg/kg
IV/IO over 20 minutes IV/IO over 20 minutes

20
min
After start
of step 3
(start of infusion)
Still
fitting?
No Monitor

S Yes

T An anaesthetist MUST be present

E
P RSI with thiopental (thiopentone)