Here is a brief talk on managing patients with status.
The definition of Status Epilepticus is a seizure lasting more or equal to 30 minutes, or several seizures without complete resolution between seizures.
The options for inititally treating seizures is to give a choice of benzodiazepines. The choice of benzos is between diazepam, which has long been used and midazolam. Each has pros and cons. Diazepam has the advantages of being able to be given rectally if no IV access is available. The doses are different. Midazolam has the advantages of being given IM or IV, with similar bioavailability profiles. The doses are the same 0.15mg/kg. I prefer this drug. Easy to remember one dose and easy to give.
If the seizure continues, it is appropriate to give more benzodiazepine. It may also be prudent to load with phenytoin. Be aware that too rapid a load with this may cause hypotension. If the patient is already on phenytoin, the question becomes are they taking their meds. It is appropriate to load, in children we will half load.
If the seizure ends at this point, it will be important to manage the airway as these patients are post-ictal with significant sedation on-board. All that may be required is some jaw thrust in combination with high flow oxygen.
If the patient continues to seize, intubation is then considered. Use of thiopentone (which is effective in stopping seizures), for both intubation and as an infusion, works well.
BEWARE, although the tonic-clonic component of the seizure is over, the patient may still have neuronal seizure activity. This may sometimes be picked up by tachycardia, but the most reliable way to monitor is by eeg.
