Page 329 - ILAE_Lectures_2015

Table 1. General measures for the patient presenting with tonic-clonic status epilepticus.
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1st stage (0 10 minutes)
Assess cardiorespiratory function
Secure airway and resuscitate
Administer oxygen

2nd stage (060 minutes)
Institute regular monitoring (see text)
Emergency AED therapy (see text)
Set up intravenous lines
Emergency investigations (see text)
Administer glucose (50 ml of 50% solution) and/or intravenous thiamine (250 mg) as high
potency intravenous Pabrinex where appropriate
Treat acidosis if severe

3rd stage (060/90 minutes)
Establish aetiology
Identify and treat medical complications
Pressor therapy when appropriate

4th stage (3090 minutes)
Transfer to intensive care
Establish intensive care and EEG monitoring (see text)
Initiate intracranial pressure monitoring where appropriate
Initiate long-term, maintenance, antiepileptic therapy

These four stages should be followed chronologically; the 1st and 2nd within 10 minutes, and
stage 4 (transfer to intensive care unit) in most settings within 6090 minutes of presentation.

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2nd stage (060 minutes)

Monitoring. Regular neurological observations and measurements of pulse, blood pressure,
ECG, and temperature should be initiated. Metabolic abnormalities may cause status
epilepticus, or develop during its course, and biochemical, blood gas, pH, clotting, and
haematological measures should be monitored.

Emergency anticonvulsant therapy should be started.

Intravenous lines should be set up for fluid replacement and drug administration (preferably
with 0.9% sodium chloride (normal or physiological saline) rather than 5% glucose
solutions). Drugs should not be mixed and, if two antiepileptic drugs (AEDs) are needed (for
example, phenytoin and diazepam), two intravenous lines should be sited. The lines should
be in large veins, as many AEDs cause phlebitis and thrombosis at the site of infusion. Arterial
lines must never be used for drug administration.

Emergency investigations. Blood should be drawn for the emergency measurement of blood
gases, sugar, renal and liver function, calcium and magnesium levels, full haematological
screen (including platelets), blood clotting measures, and anticonvulsant levels; 50 ml of