MSC Neuro 25 p2

IV benzodiazepine:

Lorazepam 4 mg IV (preferred) OR

Diazepam 10 mg IV (slow) OR

Midazolam IM/buccal if IVnot available. Step 3 (Second-line drug, if seizure persists 10–30 min):

IV phenytoin/fosphenytoin OR

Valproate IV (20–40 mg/kg) OR

Levetiracetam IV.

Step 4 (Refractory SE, >30–60 min):

ICU transfer.

Anesthesia: Midazolam infusion, Propofol infusion, or Thiopental sodium (barbiturate coma).

Continuous EEG monitoring.

Additional measures:

Treat cause (stroke, meningitis, electrolyte imbalance).

ICPmanagement if cerebral edema.

Exam Pearls

Status epilepticus = >5 min seizure or no return of consciousness.

Convulsive SE = medical emergency (ABC first, then drugs).

First-line = benzodiazepine IV.

If fails → fosphenytoin/valproate/levetiracetam.

If fails → anesthesia in ICU.