Symptomdx.

Get Started

SeizureAPPROACH

NEUROLOGIC · 19 SECTIONS

⚲

460 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Transient Neurologic Deficits Acute Aphasia And Speech Disturbance Acute Confusion And Delirium Postictal State And Seizure Recurrence Concern Seizure Acute Vision Loss New Tremor And Involuntary Movements Headache Vertigo Acute Weakness Or Numbness Gait Instability And Ataxia

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx48

Event details

›Event characteristics

›Witnessed

›Unwitnessed

›Time last known normal

›Duration estimate

›Single event

›Cluster

›Convulsive features

›Nonconvulsive features

›Eye deviation

›Head turning

›Focal motor onset

›Speech arrest

›Automatisms

›Cyanosis

›Incontinence

›Tongue bite lateral

›Tongue bite anterior

Prodrome and triggers

›Pre event context

›Fever

›Sleep deprivation

›Missed antiseizure medication

›Alcohol recent heavy use

›Alcohol cessation timing

›Benzodiazepine cessation timing

›Stimulant use

02Alarm Features/alarm36

Immediate resuscitation triggers

›Time critical threats

›Ongoing seizure 5 minutes or longer

›Recurrent seizures without baseline recovery

›Airway compromise

›Hypoxia

›Hypotension

›Hypoglycemia

›Hyperthermia

›Trauma with depressed consciousness

›Suspected meningitis or encephalitis

›Pregnancy with seizure

›Eclampsia concern

Vital sign danger thresholds

›High risk vitals

›SpO2 less than 92 percent on room air

›Systolic blood pressure less than 90

›Respiratory rate less than 10

›Respiratory rate greater than 30

›Temperature 38.5 or higher

›Temperature 40 or higher

›Glucose less than 3.0 mmol per L

High risk clinical features

›High risk presentation

›New focal neurologic deficit

›Persistent altered mental status

›Severe headache

›Thunderclap headache

03Medications/meds26

Antiseizure and adherence

›Antiseizure medication profile

›Current antiseizure medications

›Last dose timing

›Recent dose change

›Missed doses

›Rescue medication at home

›Adverse effects

›Recent discontinuation

Drugs that lower seizure threshold

›Seizure threshold lowering exposures

›Bupropion

›Tramadol

›Theophylline

›Clozapine

›Lithium toxicity

›Isoniazid

›Diphenhydramine high dose

›Fluoroquinolones

Anticoagulants and antiplatelets

›Bleeding risk medications

›DOACs

›Warfarin

›Antiplatelet therapy

›Recent reversal agents

Pregnancy related medications

›Pregnancy relevant meds

›Magnesium sulfate current

04Diet/diet15

Intake and metabolic stress

›Recent intake pattern

›Poor oral intake

›Vomiting

›Diarrhea

›Dehydration concern

›Prolonged fasting

›Ketogenic diet

Caffeine and energy drinks

›Stimulant dietary exposures

›High caffeine intake

›Energy drink use

›Pre workout supplements

Alcohol pattern

›Alcohol exposure timing

›Heavy daily use

›Last drink timing

›Withdrawal symptoms

05Review of Systems/ros27

Neurologic

›Neuro symptoms

›Headache

›New weakness

›New numbness

›Vision change

›Speech change

›Gait change

›Syncope prodrome

Infectious and inflammatory

›Infection symptoms

›Fever

›Chills

›Neck stiffness

›Photophobia

›Rash

›Recent infection

Cardiopulmonary

›Cardiorespiratory symptoms

›Chest pain

›Palpitations

›Dyspnea

›Pleuritic pain

›Hemoptysis

GI and metabolic

›Metabolic symptoms

›Polyuria

›Polydipsia

06Collateral History and Family History/chafh9

Witness and EMS report

›Collateral sources

›EMS timeline and treatments

›Witness description of onset

›Video available

›Baseline mental status confirmation

Family history

›Genetic and familial risk

›Epilepsy in first degree relatives (Z82.0)

›Sudden unexplained death in family

›Arrhythmia syndromes in family

07Risk Factors/rf22

Structural brain risk

›CNS injury risk

›Prior stroke (I63.9)

›Prior intracranial hemorrhage (I62.9)

›Traumatic brain injury (S06.9)

›Brain tumor (C71.9)

›Neurocysticercosis exposure

Infection and inflammation risk

›CNS infection risk

›Immunosuppression

›HIV (B20)

›Recent travel

›Tick exposure

›TB exposure

Toxic and withdrawal risk

›Substance related risk

›Alcohol withdrawal risk

›Benzodiazepine withdrawal risk

›Stimulant intoxication risk

›Medication overdose risk

Pregnancy postpartum risk

›Obstetric risk

›Pregnancy

›Postpartum under 6 weeks

›Hypertension in pregnancy

›Preeclampsia features

08Differential Diagnosis/ddx36

Life threatening

›Cannot miss diagnoses

›Status epilepticus (G41.9)

›Hypoglycemia

›CNS infection meningitis or encephalitis

›Intracranial hemorrhage

›Subarachnoid hemorrhage

›Acute ischemic stroke with seizure (I63.9)

›Toxic ingestion

›Alcohol withdrawal (F10.239)

›Eclampsia (O15.9)

›Cardiac arrhythmia with convulsive syncope

Common

›Common etiologies

›Breakthrough seizure in epilepsy (G40.909)

›Missed antiseizure medication

›Sleep deprivation related

›Substance intoxication

›Fever related seizure in children (R56.0)

›Metabolic derangement

Less common

›Less common etiologies

›Hyponatremia (E87.1)

›Hypocalcemia (E83.51)

›Hypomagnesemia (E83.42)

›Uremia (N19)

›Hepatic encephalopathy with seizure (K72.90)

›Autoimmune encephalitis

09Past Medical History/pmh15

Neurologic history

›Neurologic conditions

›Epilepsy syndrome

›Prior stroke

›Dementia (F03.90)

›Multiple sclerosis (G35)

›Migraine (G43.909)

Medical comorbidities

›Systemic conditions

›Diabetes mellitus (E11.9)

›Chronic kidney disease (N18.9)

›Cirrhosis (K74.60)

›Alcohol use disorder (F10.20)

Procedures and devices

›Devices and procedures

›Ventriculoperitoneal shunt

›Vagus nerve stimulator

›Recent surgery

10Physical Exam/exam36

Primary survey and safety

›ABCDE and immediate findings

›Airway patency

›Respiratory effort

›Oxygen saturation trend

›Hemodynamics

›Temperature

›Ongoing convulsions

›Postictal agitation safety risk

Neurologic exam

›Neuro localization

›Mental status baseline

›Pupils size and reactivity

›Gaze deviation

›Facial symmetry

›Motor strength gross

›Sensation gross

›Pronator drift

›Coordination

›Speech and language

›Meningismus

Trauma survey

›Injury assessment

›Scalp hematoma

›Facial trauma

›Tongue laceration

›Shoulder dislocation

›Cervical spine tenderness

11Lab Studies/labs25

Core tests

›Immediate core labs

›Point of care glucose

›Electrolytes sodium potassium calcium magnesium

›CBC

›Creatinine and urea

›Liver enzymes

Targeted tests by context

›Context driven labs

›Pregnancy test

›Serum ethanol

›Creatine kinase for rhabdomyolysis

›Venous blood gas for acidosis

›Lactate trend if persistent shock

Antiseizure drug levels

›Therapeutic drug monitoring

›Phenytoin level

›Valproate level

›Carbamazepine level

Toxicology

›Tox workup

›Acetaminophen level

›Salicylate level

›Urine drug screen limits

CSF studies when indicated

›Lumbar puncture labs

›CSF cell count and differential

›CSF glucose and protein

12Imaging/img21

Scoring Systems

›Decision tools supporting imaging decisions

›Canadian CT Head Rule for post seizure head injury

›NEXUS or Canadian C spine rule for post seizure trauma

›Ottawa SAH Rule when thunderclap headache present

MRI

›MRI brain considerations

›New focal deficit with nondiagnostic CT

›Suspected tumor or vascular malformation

›Suspected encephalitis with persistent altered mental status

›Epilepsy workup outpatient pathway when stable

›CT head indications in ED

›New focal neurologic deficit

›Persistent altered mental status

›Fever or immunocompromised

›Head trauma

›Anticoagulation

›Known malignancy

›First unprovoked seizure with high risk features

Ultrasound

›Bedside ultrasound roles

›Pregnancy assessment when indicated

›FAST when trauma suspected

›Cardiac POCUS for shock states

13Special Tests/spec14

EEG

›EEG indications

›Concern for nonconvulsive status epilepticus

›Persistent altered mental status unexplained

›Subtle rhythmic motor findings

›Postictal state prolonged

Lumbar puncture decision points

›CSF pathway

›Fever with seizure and meningismus

›Immunocompromised with new seizure

›Persistent encephalopathy

›CT before LP when focal deficit or papilledema concern

Other bedside tests

›Bedside diagnostics

›Capillary glucose repeat if altered

›Temperature core measurement

›End tidal CO2 monitoring in sedation

14ECG/ecg12

When ECG matters

›ECG indications

›First seizure in older adult

›Syncope features

›Palpitations

›Family history sudden death

›Prolonged QT risk medications

High risk patterns

›ECG red flags

›Long QT

›Brugada pattern

›WPW pattern

›High grade AV block

›Ventricular tachycardia

15Assessment/ax14

Working problem list

›Seizure phenotype and severity

›Convulsive seizure resolved

›Status epilepticus suspected

›Refractory status epilepticus suspected

›Postictal state resolving

›Persistent encephalopathy

Etiology classification

›Cause category

›Provoked seizure acute symptomatic

›Metabolic trigger identified

›Toxic or withdrawal trigger identified

›Unprovoked seizure

›First unprovoked seizure

›Known epilepsy breakthrough

›Mimic more likely than epileptic seizure

16Plan/plan53

Differential Management

›!Seizure (first-time)→›!Status epilepticus→›Seizure (breakthrough-known epilepsy)→›Hemorrhagic stroke (intracerebral)→

First 5 minutes

›Immediate stabilization

›If ongoing convulsions then time from onset

›If SpO2 less than 92 percent then oxygen

›If inadequate ventilation then bag mask ventilation

›If refractory hypoxia then prepare intubation

›Cardiac monitor

›Two IV lines or IO

›Point of care glucose

›If glucose low then dextrose per local protocol

Convulsive status epilepticus algorithm

›Medication sequence adult typical pathway local protocol dependent

›First line benzodiazepine

›Lorazepam IV 0.1 mg per kg

›Maximum single dose 4 mg

›May repeat once after 5 to 10 minutes

›Midazolam IM 10 mg if no IV access

›Midazolam intranasal 0.2 mg per kg option

›Second line antiseizure load

›Levetiracetam IV 60 mg per kg

›Maximum 4500 mg

›Fosphenytoin IV 20 mg PE per kg

›Maximum 1500 mg PE

17Disposition/dispo24

ICU criteria

›ICU level care indicators

›Status epilepticus

›Refractory seizures requiring infusion

›Intubation

›Persistent hemodynamic instability

›Hyperthermia

Inpatient admission criteria

›Admission indicators

›New focal neurologic deficit

›Abnormal CT acute finding

›Persistent altered mental status

›CNS infection concern

›Significant metabolic derangement requiring correction

›Unsafe home supervision

Observation pathway

›Observation candidates

›First seizure with normal exam and normal initial tests

›Prolonged postictal but improving

›Medication nonadherence corrected with reliable follow up

Discharge criteria

›Discharge requirements

›Back to baseline mental status

›Normal neuro exam

›No high risk features

›Reliable supervision

›Follow up arranged

›Driving restrictions reviewed

18Discharge Instructions/di11

Copy discharge instructions

›Patient instructions

›You were seen for a seizure that has stopped and you have returned to your usual baseline

›Do not drive until cleared by your clinician or local regulations

›Avoid swimming alone baths alone ladders and heights until cleared

›Take your antiseizure medication exactly as prescribed and do not miss doses

›Avoid alcohol and recreational drugs

›Sleep regularly and avoid sleep deprivation

›Follow up with your family doctor or neurology within the recommended timeframe

›Return to the emergency department if another seizure lasts 5 minutes or longer

›Return to the emergency department if you have repeated seizures without full recovery between them

›Return to the emergency department for fever severe headache stiff neck new weakness confusion that does not improve or head injury

19References/r16

Guidelines and decision support

›American College of Emergency Physicians Clinical Policy Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Seizures 2024

›Annals of Emergency Medicine publication

›Adult ED seizure evaluation and management

›American Epilepsy Society Evidence Based Guideline Treatment of Convulsive Status Epilepticus in Children and Adults 2016

›Benzodiazepine first line and second line options

›Time based treatment algorithm

›International League Against Epilepsy Definition and Classification of Status Epilepticus 2015

›t1 5 minutes for convulsive status

›t2 30 minutes for convulsive status

›NICE Guideline NG217 Epilepsies in children young people and adults 2025

›EEG supports diagnosis and not exclusion

›EEG timing ideally within 72 hours when requested

›Canadian Paediatric Society Emergency management of the paediatric patient with convulsive status epilepticus 2021

›Pediatric ED algorithm and dosing tables

›Infant older than 1 month guidance

›Project instructions file

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

SeizureAPPROACH

NEUROLOGIC · 19 SECTIONS

⚲

460 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx48

Event details

›Event characteristics

›Witnessed

›Unwitnessed

›Time last known normal

›Duration estimate

›Single event

›Cluster

›Convulsive features

›Nonconvulsive features

›Eye deviation

›Head turning

›Focal motor onset

›Speech arrest

›Automatisms

›Cyanosis

›Incontinence

›Tongue bite lateral

›Tongue bite anterior

Prodrome and triggers

›Pre event context

›Fever

›Sleep deprivation

›Missed antiseizure medication

›Alcohol recent heavy use

›Alcohol cessation timing

›Benzodiazepine cessation timing

›Stimulant use

02Alarm Features/alarm36

Immediate resuscitation triggers

›Time critical threats

›Ongoing seizure 5 minutes or longer

›Recurrent seizures without baseline recovery

›Airway compromise

›Hypoxia

›Hypotension

›Hypoglycemia

›Hyperthermia

›Trauma with depressed consciousness

›Suspected meningitis or encephalitis

›Pregnancy with seizure

›Eclampsia concern

Vital sign danger thresholds

›High risk vitals

›SpO2 less than 92 percent on room air

›Systolic blood pressure less than 90

›Respiratory rate less than 10

›Respiratory rate greater than 30

›Temperature 38.5 or higher

›Temperature 40 or higher

›Glucose less than 3.0 mmol per L

High risk clinical features

›High risk presentation

›New focal neurologic deficit

›Persistent altered mental status

›Severe headache

›Thunderclap headache

03Medications/meds26

Antiseizure and adherence

›Antiseizure medication profile

›Current antiseizure medications

›Last dose timing

›Recent dose change

›Missed doses

›Rescue medication at home

›Adverse effects

›Recent discontinuation

Drugs that lower seizure threshold

›Seizure threshold lowering exposures

›Bupropion

›Tramadol

›Theophylline

›Clozapine

›Lithium toxicity

›Isoniazid

›Diphenhydramine high dose

›Fluoroquinolones

Anticoagulants and antiplatelets

›Bleeding risk medications

›DOACs

›Warfarin

›Antiplatelet therapy

›Recent reversal agents

Pregnancy related medications

›Pregnancy relevant meds

›Magnesium sulfate current

04Diet/diet15

Intake and metabolic stress

›Recent intake pattern

›Poor oral intake

›Vomiting

›Diarrhea

›Dehydration concern

›Prolonged fasting

›Ketogenic diet

Caffeine and energy drinks

›Stimulant dietary exposures

›High caffeine intake

›Energy drink use

›Pre workout supplements

Alcohol pattern

›Alcohol exposure timing

›Heavy daily use

›Last drink timing

›Withdrawal symptoms

05Review of Systems/ros27

Neurologic

›Neuro symptoms

›Headache

›New weakness

›New numbness

›Vision change

›Speech change

›Gait change

›Syncope prodrome

Infectious and inflammatory

›Infection symptoms

›Fever

›Chills

›Neck stiffness

›Photophobia

›Rash

›Recent infection

Cardiopulmonary

›Cardiorespiratory symptoms

›Chest pain

›Palpitations

›Dyspnea

›Pleuritic pain

›Hemoptysis

GI and metabolic

›Metabolic symptoms

›Polyuria

›Polydipsia

06Collateral History and Family History/chafh9

Witness and EMS report

›Collateral sources

›EMS timeline and treatments

›Witness description of onset

›Video available

›Baseline mental status confirmation

Family history

›Genetic and familial risk

›Epilepsy in first degree relatives (Z82.0)

›Sudden unexplained death in family

›Arrhythmia syndromes in family

07Risk Factors/rf22

Structural brain risk

›CNS injury risk

›Prior stroke (I63.9)

›Prior intracranial hemorrhage (I62.9)

›Traumatic brain injury (S06.9)

›Brain tumor (C71.9)

›Neurocysticercosis exposure

Infection and inflammation risk

›CNS infection risk

›Immunosuppression

›HIV (B20)

›Recent travel

›Tick exposure

›TB exposure

Toxic and withdrawal risk

›Substance related risk

›Alcohol withdrawal risk

›Benzodiazepine withdrawal risk

›Stimulant intoxication risk

›Medication overdose risk

Pregnancy postpartum risk

›Obstetric risk

›Pregnancy

›Postpartum under 6 weeks

›Hypertension in pregnancy

›Preeclampsia features

08Differential Diagnosis/ddx36

Life threatening

›Cannot miss diagnoses

›Status epilepticus (G41.9)

›Hypoglycemia

›CNS infection meningitis or encephalitis

›Intracranial hemorrhage

›Subarachnoid hemorrhage

›Acute ischemic stroke with seizure (I63.9)

›Toxic ingestion

›Alcohol withdrawal (F10.239)

›Eclampsia (O15.9)

›Cardiac arrhythmia with convulsive syncope

Common

›Common etiologies

›Breakthrough seizure in epilepsy (G40.909)

›Missed antiseizure medication

›Sleep deprivation related

›Substance intoxication

›Fever related seizure in children (R56.0)

›Metabolic derangement

Less common

›Less common etiologies

›Hyponatremia (E87.1)

›Hypocalcemia (E83.51)

›Hypomagnesemia (E83.42)

›Uremia (N19)

›Hepatic encephalopathy with seizure (K72.90)

›Autoimmune encephalitis

09Past Medical History/pmh15

Neurologic history

›Neurologic conditions

›Epilepsy syndrome

›Prior stroke

›Dementia (F03.90)

›Multiple sclerosis (G35)

›Migraine (G43.909)

Medical comorbidities

›Systemic conditions

›Diabetes mellitus (E11.9)

›Chronic kidney disease (N18.9)

›Cirrhosis (K74.60)

›Alcohol use disorder (F10.20)

Procedures and devices

›Devices and procedures

›Ventriculoperitoneal shunt

›Vagus nerve stimulator

›Recent surgery

10Physical Exam/exam36

Primary survey and safety

›ABCDE and immediate findings

›Airway patency

›Respiratory effort

›Oxygen saturation trend

›Hemodynamics

›Temperature

›Ongoing convulsions

›Postictal agitation safety risk

Neurologic exam

›Neuro localization

›Mental status baseline

›Pupils size and reactivity

›Gaze deviation

›Facial symmetry

›Motor strength gross

›Sensation gross

›Pronator drift

›Coordination

›Speech and language

›Meningismus

Trauma survey

›Injury assessment

›Scalp hematoma

›Facial trauma

›Tongue laceration

›Shoulder dislocation

›Cervical spine tenderness

11Lab Studies/labs25

Core tests

›Immediate core labs

›Point of care glucose

›Electrolytes sodium potassium calcium magnesium

›CBC

›Creatinine and urea

›Liver enzymes

Targeted tests by context

›Context driven labs

›Pregnancy test

›Serum ethanol

›Creatine kinase for rhabdomyolysis

›Venous blood gas for acidosis

›Lactate trend if persistent shock

Antiseizure drug levels

›Therapeutic drug monitoring

›Phenytoin level

›Valproate level

›Carbamazepine level

Toxicology

›Tox workup

›Acetaminophen level

›Salicylate level

›Urine drug screen limits

CSF studies when indicated

›Lumbar puncture labs

›CSF cell count and differential

›CSF glucose and protein

12Imaging/img21

Scoring Systems

›Decision tools supporting imaging decisions

›Canadian CT Head Rule for post seizure head injury

›NEXUS or Canadian C spine rule for post seizure trauma

›Ottawa SAH Rule when thunderclap headache present

MRI

›MRI brain considerations

›New focal deficit with nondiagnostic CT

›Suspected tumor or vascular malformation

›Suspected encephalitis with persistent altered mental status

›Epilepsy workup outpatient pathway when stable

›CT head indications in ED

›New focal neurologic deficit

›Persistent altered mental status

›Fever or immunocompromised

›Head trauma

›Anticoagulation

›Known malignancy

›First unprovoked seizure with high risk features

Ultrasound

›Bedside ultrasound roles

›Pregnancy assessment when indicated

›FAST when trauma suspected

›Cardiac POCUS for shock states

13Special Tests/spec14

EEG

›EEG indications

›Concern for nonconvulsive status epilepticus

›Persistent altered mental status unexplained

›Subtle rhythmic motor findings

›Postictal state prolonged

Lumbar puncture decision points

›CSF pathway

›Fever with seizure and meningismus

›Immunocompromised with new seizure

›Persistent encephalopathy

›CT before LP when focal deficit or papilledema concern

Other bedside tests

›Bedside diagnostics

›Capillary glucose repeat if altered

›Temperature core measurement

›End tidal CO2 monitoring in sedation

14ECG/ecg12

When ECG matters

›ECG indications

›First seizure in older adult

›Syncope features

›Palpitations

›Family history sudden death

›Prolonged QT risk medications

High risk patterns

›ECG red flags

›Long QT

›Brugada pattern

›WPW pattern

›High grade AV block

›Ventricular tachycardia

15Assessment/ax14

Working problem list

›Seizure phenotype and severity

›Convulsive seizure resolved

›Status epilepticus suspected

›Refractory status epilepticus suspected

›Postictal state resolving

›Persistent encephalopathy

Etiology classification

›Cause category

›Provoked seizure acute symptomatic

›Metabolic trigger identified

›Toxic or withdrawal trigger identified

›Unprovoked seizure

›First unprovoked seizure

›Known epilepsy breakthrough

›Mimic more likely than epileptic seizure

16Plan/plan53

Differential Management

›!Seizure (first-time)→›!Status epilepticus→›Seizure (breakthrough-known epilepsy)→›Hemorrhagic stroke (intracerebral)→

First 5 minutes

›Immediate stabilization

›If ongoing convulsions then time from onset

›If SpO2 less than 92 percent then oxygen

›If inadequate ventilation then bag mask ventilation

›If refractory hypoxia then prepare intubation

›Cardiac monitor

›Two IV lines or IO

›Point of care glucose

›If glucose low then dextrose per local protocol

Convulsive status epilepticus algorithm

›Medication sequence adult typical pathway local protocol dependent

›First line benzodiazepine

›Lorazepam IV 0.1 mg per kg

›Maximum single dose 4 mg

›May repeat once after 5 to 10 minutes

›Midazolam IM 10 mg if no IV access

›Midazolam intranasal 0.2 mg per kg option

›Second line antiseizure load

›Levetiracetam IV 60 mg per kg

›Maximum 4500 mg

›Fosphenytoin IV 20 mg PE per kg

›Maximum 1500 mg PE

17Disposition/dispo24

ICU criteria

›ICU level care indicators

›Status epilepticus

›Refractory seizures requiring infusion

›Intubation

›Persistent hemodynamic instability

›Hyperthermia

Inpatient admission criteria

›Admission indicators

›New focal neurologic deficit

›Abnormal CT acute finding

›Persistent altered mental status

›CNS infection concern

›Significant metabolic derangement requiring correction

›Unsafe home supervision

Observation pathway

›Observation candidates

›First seizure with normal exam and normal initial tests

›Prolonged postictal but improving

›Medication nonadherence corrected with reliable follow up

Discharge criteria

›Discharge requirements

›Back to baseline mental status

›Normal neuro exam

›No high risk features

›Reliable supervision

›Follow up arranged

›Driving restrictions reviewed

18Discharge Instructions/di11

Copy discharge instructions

›Patient instructions

›You were seen for a seizure that has stopped and you have returned to your usual baseline

›Do not drive until cleared by your clinician or local regulations

›Avoid swimming alone baths alone ladders and heights until cleared

›Take your antiseizure medication exactly as prescribed and do not miss doses

›Avoid alcohol and recreational drugs

›Sleep regularly and avoid sleep deprivation

›Follow up with your family doctor or neurology within the recommended timeframe

›Return to the emergency department if another seizure lasts 5 minutes or longer

›Return to the emergency department if you have repeated seizures without full recovery between them

›Return to the emergency department for fever severe headache stiff neck new weakness confusion that does not improve or head injury

19References/r16

Guidelines and decision support

›American College of Emergency Physicians Clinical Policy Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Seizures 2024

›Annals of Emergency Medicine publication

›Adult ED seizure evaluation and management

›American Epilepsy Society Evidence Based Guideline Treatment of Convulsive Status Epilepticus in Children and Adults 2016

›Benzodiazepine first line and second line options

›Time based treatment algorithm

›International League Against Epilepsy Definition and Classification of Status Epilepticus 2015

›t1 5 minutes for convulsive status

›t2 30 minutes for convulsive status

›NICE Guideline NG217 Epilepsies in children young people and adults 2025

›EEG supports diagnosis and not exclusion

›EEG timing ideally within 72 hours when requested

›Canadian Paediatric Society Emergency management of the paediatric patient with convulsive status epilepticus 2021

›Pediatric ED algorithm and dosing tables

›Infant older than 1 month guidance

›Project instructions file

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.