top of page

🌟 Status epilepticus

 🎯 Pathology

  • a life-threatening neurological condition that requires immediate intervention

  • definition:

    • a continuous seizure lasting more than 5 minutes, or

    • recurrent seizure activity without regaining consciousness in between seizures

 

🩺 Initial management (ABCDE approach)

  • Airway

    • place in the recovery position

    • airway manoeuvre: jaw thrust

    • secure airway with nasopharyngeal tube (avoid oropharyngeal airway due to trismus)

  • Breathing

    • 15L/min oxygen with a non-rebreather mask

  • Circulation

    • ​insert 2 large bore IV cannula

      • take bloods: venous blood gas and venous blood

      • drug delivery for pharmacological management (check below)

  • Disability

    • check capillary glucose

  • Everything else

    • full neurological examination

​

💉 Pharmacological management

  • 1st line: benzodiazepines

    • pre-hospital setting: PR diazepam or buccal midazolam

    • hospital setting: IV lorazepam

  • if no improvement within 5-10 minutes

    • repeat dose of benzodiazepines

  • if no improvement within 10 minutes

    • phenytoin

    • call anaesthetist

  • if no improvement within 20 minutes

    • rapid sequence intubation (RSI) with thiopentone

​

🕵️‍♂️ Further investigations

  • CT/MRI brain

  • electroencephalogram (EEG)

  • lumbar puncture

​

💡 Common causes of seizures

  • intra-cerebral

    • space-occupying lesion

    • intracerebral bleed

    • infection (e.g. meningitis, encephalitis)

  • substance misuse

    • alcohol withdrawal

    • recreational drugs

  • metabolic

    • hypoglycaemia

    • hypomagnesaemia

    • hyperthyroidism

bottom of page