Status Quo on Status Epilepticus?

Got a patient with seizures that won’t stop? Consider these medications:

1. Midazolam:
   • IntraNASAL 0.25 mg/kg
     • Note the lower dose
     • Consider the use of mucosal atomization device to promote absorption
     • If > 1 mL, split between nostrils
     • May be faster than IV; superior to rectal
   • CRI 0.2-1 mg/kg/h
2. Levetiracetam:
   • 20-60 mg/kg IV q6-8h
3. Phenobarbital:
   • 2-6 mg/kg IV q6-12h
4. Propofol:
   • 2-6 mg/kg IV then 6 mg/kg/h (titrate to effect)
5. Ketamine:
   • 1-5 mg/kg then 0.1-0.5 mg/kg/h CRI
6. Dexmedetomidine:
   • 3 mcg/kg IV bolus then 3 mcg/kg/h CRI
7. Mild hypothermia:
   • Target 36.7°C (98°F)
8. Inhalant

Other considerations include:

1. Increased intracranial pressure:
   • Hypertonic saline
   • Mannitol
2. Hyperthermia:
   • Provide active cooling (fan & spray pet with water) until ~39.5°C (103°F).
3. Hypoglycemia:
   • 50% dextrose: 0.5 mL/kg IV
4. Hypocalcemia:
   • 10% calcium gluconate: 3 mL per “cat” or 1 mL per kg

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