Emergency Medicine Board Bombs 281. Status Epilepticus: What to Do When Seizures Won’t Stop
Mar 31, 2026
A rapid walkthrough of treating continuous seizures and when to escalate care. Clear steps on initial benzodiazepine dosing and when to load antiseizure medications. Practical guidance on airway decisions, risks of paralytics masking activity, and options for refractory seizures including sedation and ketamine. Quick recap of common exam traps and essential metabolic checks.
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Case Example Drives The Algorithm
- Blake Briggs uses a case of a 54-year-old man seizing for 8 minutes to teach the algorithm.
- EMS gave two 4 mg lorazepam doses with no response, prompting immediate levetiracetam as the correct next step.
Hit Benzos Hard And Early
- Give full-dose benzodiazepines early for status epilepticus.
- Lorazepam IV 4 mg for adults or midazolam IM 10 mg if no IV, and avoid underdosing or hesitating to hit the full dose.
Definition Includes Failure To Return To Baseline
- Status epilepticus is any seizure >5 minutes or any seizure without return to baseline between events.
- A postictal-but-not-baseline patient who has another seizure qualifies as status.