Clinical Pathway for Evaluation/Treatment of
Infants and Children > 2 months with Status Epilepticus
0-5 min
Triage
- MD/CRNP/RN Immediate Management
- ABCDE, Oxygen, Monitors
- IV access, Glucose POC
- Brief H&P
- Initial Laboratory Studies
- CBC, CMP, Mg, Phos
HCG, tox screen, anticonvulsant levels as indicated
- CBC, CMP, Mg, Phos
Rapid administration of anti-seizure medications is necessary to stop the seizure. Anticipation/preparation of the next medication is essential.
5-10 min
1st Medication
1st Medication
Prepare/Administer 1st Lorazepam
0.1 mg/kg IV, max 4 mg
Prepare 2nd Lorazepam
0.1 mg/kg IV, max 4 mg
0.1 mg/kg IV, max 4 mg
Prepare 2nd Lorazepam
0.1 mg/kg IV, max 4 mg
Reassess in 5 minutes
If no IV access, consider midazolam
Buccal IM |
0.3 mg/kg 0.2 mg/kg |
Choosing 2nd/3rd Medication:
- If on Levetiracetam < 80 mg/kg/day:
- 2nd medication Levetiracetam
- 3rd medication Fosphenytoin
- If on Levetiracetam > 80 mg/kg/day:
- 2nd medication Fosphenytoin
- 3rd medication Valproate
- If on Phenytoin:
- 2nd medication Levetiracetam
- 3rd medication Valproate
PICU Tier 2
ED Attending calls PICU Attending directly.
Preparation for ICU care and EEG monitoring.
Recommendations for 4th medication,
as needed.
Administer 2nd Lorazepam
Prepare 2nd Medication
Prepare 2nd Medication
Levetiracetam: | 60 mg/kg or |
Fosphenytoin: | 20 mg PE/kg |
Reassess in 5 minutes
Administer 2nd Medication
10-20 min
2nd Medication
2nd Medication
Reassess 5 minutes into
2nd medication infusion
2nd medication infusion
Prepare 3rd Medication
Fosphenytoin: | 20 mg PE/kg or |
Valproate: | 40 mg/kg or |
Levetiracetam: | 60 mg/kg |
Notify PICU and Neurology
Reassess at end of 2nd medication infusion
Administer 3rd Medication
20-40 min
3rd Medication
3rd Medication
Primary Team Management with Neurology consultation
PICU Management for Refractory Status Epilepticus
Continuous anesthetic infusions:Midazolam | Pentobarbital | Ketamine
Posted: November 2008
Revised: September 2021
Authors: N. Abend, MD; A. Topjian, MD; R. Ichord, MD; K. Resendiz Trujano, Pharm D.; J. Fein, MD; K. Lourie, RN; K. Young, RN;
J. Lavelle, MD; D. Dlugos, MD;
Revised: September 2021
Authors: N. Abend, MD; A. Topjian, MD; R. Ichord, MD; K. Resendiz Trujano, Pharm D.; J. Fein, MD; K. Lourie, RN; K. Young, RN;
J. Lavelle, MD; D. Dlugos, MD;
Media
- PEM Podcast: Pediatric STATUS EPILEPTICUS: A-B-C-Drugs
- CHOP PEM Podcast: Episode 3 - Status Epilepticus
Related Links
- Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society
- Guidelines for the Evaluation and Management of Status Epilepticus
- Status Epilepticus and Refractory Status Epilepticus Management
- Generalized Convulsive Status Epilepticus in Adults and Children: Treatment Guidelines and Protocols
- Practice Parameter: Diagnostic Assessment of the Child With Status Epilepticus (an evidence-based review)
- Time From Convulsive Status Epilepticus Onset to Anticonvulsant Administration in Children