🧠 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.
Convulsive Status Epilepticus Staged Management
Current stage
IV access
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.