Convulsive Status Epilepticus Staged Management — free guideline decision tool

Stage convulsive status epilepticus by time and give the first-line, second-line and refractory drug plan plus whole-course points. Instant, browser-side.

5–20 min (first-line): full-dose benzodiazepine (lorazepam 0.1 mg/kg ≤ 4 mg, or diazepam 0.15–0.2 mg/kg ≤ 10 mg IV; IM midazolam 10 mg if no IV). 20–40 min (second-line): IV valproate 40 mg/kg, levetiracetam 60 mg/kg, or (fos)phenytoin 20 mg/kg PE — equivalent (ESETT). > 40 min / two lines failed (refractory): continuous anesthetic infusion + intubation + cEEG in ICU.

Staged emergency management of convulsive status epilepticus.

Treat as status epilepticus once a convulsion exceeds 5 minutes; earlier control gives a better prognosis. The three second-line agents are equivalent in efficacy (ESETT) — choose by availability and patient factors. Throughout, address ABC, monitor cardiac/oxygenation, check glucose (give dextrose + thiamine if low) and find the trigger. Refractory status needs continuous IV anesthetic (midazolam/propofol/thiopental) with continuous EEG to target seizure control or burst-suppression.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Current stage 5–20 min (first-line), IV access Yes → Result: Current action First-line: benzodiazepine（Drug: IV benzodiazepine: lorazepam 0.1 mg/kg (single dose ≤ 4 mg), or diazepam 0.15–0.2 mg/kg (≤ 10 mg) IV push; may repeat once if not stopped in 5 minutes, Whole-course: Simultaneously address ABC (airway/breathing/circulation), cardiac/oximetry monitoring, check glucose (give 50% dextrose + thiamine if hypoglycemic), investigate and treat triggers (drug withdrawal, infection, electrolytes, toxins, etc.), Timeline: A convulsion > 5 min is managed as SE; 5–20 min first-line, 20–40 min second-line, > 40 min or two lines failed is refractory; earlier control gives a better prognosis） Inputs: Current stage > 40 min / two lines failed (refractory), IV access No → Result: Current action Third-line: anesthetics + ICU（Drug: Refractory SE: transfer to ICU, intubate and mechanically ventilate, continuous IV anesthetic infusion (midazolam/propofol/thiopental/pentobarbital) + continuous EEG monitoring (target seizure control or burst-suppression); actively investigate and treat the cause, Whole-course: Simultaneously address ABC (airway/breathing/circulation), cardiac/oximetry monitoring, check glucose (give 50% dextrose + thiamine if hypoglycemic), investigate and treat triggers (drug withdrawal, infection, electrolytes, toxins, etc.), Timeline: A convulsion > 5 min is managed as SE; 5–20 min first-line, 20–40 min second-line, > 40 min or two lines failed is refractory; earlier control gives a better prognosis）