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Convulsive status epilepticus

Start this sheet when: Convulsive seizure lasting 5 min or more, or two or more seizures without full recovery in between. Onset unknown: enter the arrival time as onset. Pregnant over 20 weeks or just delivered: treat as eclampsia (magnesium) until proven otherwise.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Seizure onset (clock time)

Time since door

ILAE t2: brain-injury risk (30 min): enter seizure onsetSeizure control target (60 min): enter seizure onset

Targets met --Breaches 0

1.Airway, oxygen, bedside glucose checked
≤ 5 min from door · Local target: with the first benzodiazepine
Enter door time
2.First benzodiazepine, full dose
≤ 5 min from door · AES 2016: from minute 5; no IV = IM / buccal midazolam
Enter door time
3.Second benzodiazepine dose(Still seizing)
≤ 10 min from first benzodiazepine · NICE NG217: repeat once after 5-10 min
N/AEnter door time
4.Second-line drug running(Benzo failed)
≤ 40 min from seizure onset · AES 2016: levetiracetam, valproate or fosphenytoin
N/AEnter door time
5.RSI and anaesthetic infusion started(Still seizing)
≤ 1 h from seizure onset · AES 2016: third phase 40-60 min
N/AEnter door time
6.Seizure clinically stopped
≤ 1 h from seizure onset · NCS 2012: definitive control within 60 min
Enter door time
7.CT head done(First fit, trauma, focal)
≤ 1 h from door · Local target: once seizure is controlled
N/AEnter door time
8.Neurology / EEG arranged(Not waking up)
≤ 1 h from seizure end · NCS 2012: EEG if not back to baseline
N/AEnter door time
9.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
10.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Lorazepam 0.1 mg/kg IV (max 4 mg) or midazolam 10 mg IM / buccal
☐Give the full dose; half doses prolong status and cause more intubations
☐Levetiracetam 60 mg/kg (max 4.5 g) over 10-15 min: equal to valproate and fosphenytoin
☐Avoid valproate in pregnancy, women who could be pregnant, and liver disease
☐Glucose below 70 mg/dL: 100 mL of 10% dextrose; thiamine if alcohol use
☐Eclampsia: magnesium 4 g IV over 5-10 min, then 1 g/h
☐Hunt the cause: sodium, calcium, INH (pyridoxine), neurocysticercosis, meningitis
☐After RSI, seizures hide under the paralytic: get an EEG as soon as possible

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Lorazepam 0.1 mg/kg IV (max 4 mg) or midazolam 10 mg IM / buccal

☐Give the full dose; half doses prolong status and cause more intubations

☐Levetiracetam 60 mg/kg (max 4.5 g) over 10-15 min: equal to valproate and fosphenytoin

☐Avoid valproate in pregnancy, women who could be pregnant, and liver disease

☐Glucose below 70 mg/dL: 100 mL of 10% dextrose; thiamine if alcohol use

☐Eclampsia: magnesium 4 g IV over 5-10 min, then 1 g/h

☐Hunt the cause: sodium, calcium, INH (pyridoxine), neurocysticercosis, meningitis

☐After RSI, seizures hide under the paralytic: get an EEG as soon as possible