Approach to the Critical Patient

Immediate priorities

Stabilization priorities

Ongoing seizure pathway

Time-critical seizure recognition

Immediate consult and activation

Team activation and early consultation

History

Epilepsy baseline and event characterization

Baseline epilepsy context

Medication and trigger assessment

Breakthrough trigger screen

High-risk features and secondary causes

Red flags in known epilepsy

Physical Exam

Core exam domains

General and neurologic exam

PITFALLS

Pitfalls in assessment

Differential Diagnosis

Breakthrough seizure drivers in known epilepsy

Breakthrough seizure causes

Seizure mimics and secondary emergencies

Mimics and alternative diagnoses

Laboratory Tests

Core labs for breakthrough seizure

Initial laboratory panel

Antiseizure medication levels

Antiseizure medication concentrations when applicable

Targeted labs based on presentation

Targeted testing triggers

Diagnostic Tests

Scoring Systems

Risk and severity tools

MRI

MRI brain indications and approach

CT

CT head decision pathway

Ultrasound

POCUS adjuncts

EEG

EEG indications

ECG and cardiac evaluation

Cardiac testing indications

Lumbar puncture

CSF testing triggers

Disposition

Discharge criteria in known epilepsy

ED discharge eligibility

Admission and higher level of care

Admission indications

Transfer and ICU triggers

Escalation criteria

Treatment

Breakthrough seizure without ongoing convulsions

Immediate stabilization and recurrence prevention

Convulsive status epilepticus first-line

Benzodiazepine therapy

Convulsive status epilepticus second-line

Urgent antiseizure medication loading

Refractory convulsive status epilepticus

Refractory pathway after benzodiazepine plus second-line failure

Trigger-directed therapies

Correctable cause management

Special Populations

Pregnancy

Pregnancy considerations

Geriatric

Older adult considerations

Pediatrics

Pediatric considerations

Background

Epidemiology

Epidemiology concepts

Pathophysiology

Pathophysiology overview

Therapeutic Considerations

Therapy principles

Patient Discharge Instructions

Copy discharge instructions

Discharge instructions for breakthrough seizure

References

Clinical guidelines and key sources

Evidence and guidelines

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