🧠 Convulsive Status Epilepticus Staged Management
Stage convulsive status epilepticus by time and give the first-line, second-line and refractory drug plan plus whole-course points. Instant, browser-side.
Clinical takeaway
Treat as status epilepticus once a convulsion exceeds 5 minutes; earlier control gives a better prognosis.
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When to use
Staged emergency management of convulsive status epilepticus.
How it works
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.
Key points
- 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.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Current stage | 5–20 min (first-line) |
|---|---|
| IV access | Yes |
→Current actionFirst-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
| Current stage | > 40 min / two lines failed (refractory) |
|---|---|
| IV access | No |
→Current actionThird-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
Frequently asked questions
- What is Convulsive Status Epilepticus Staged Management?
- Stage convulsive status epilepticus by time and give the first-line, second-line and refractory drug plan plus whole-course points. Instant, browser-side.
- How is Convulsive Status Epilepticus Staged Management calculated? What is the core formula?
- 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.
- When is Convulsive Status Epilepticus Staged Management used?
- Staged emergency management of convulsive status epilepticus.
- What are the key clinical points for Convulsive Status Epilepticus Staged Management?
- 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.
- What are the limits and cautions when using Convulsive Status Epilepticus Staged Management?
- 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.
- How is Convulsive Status Epilepticus Staged Management calculated in practice? Can you show a worked example?
- 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）