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Immediate stabilization
Initial priorities
Airway risk
Ongoing convulsions
Inability to protect airway
Persistent hypoxemia
Recurrent emesis
Breathing support
High flow oxygen
End tidal CO2 if available
Bag valve mask ventilation if apnea
Circulation support
Cardiac monitor
Two large bore IV or IO
Hypotension management
Isotonic crystalloid bolus 20 mL/kg
Vasopressor if shock persists
Immediate bedside checks
Point of care glucose
Core temperature
Pregnancy test if relevant
Status definition and timing
Operational definition
T1 threshold for convulsive SE 5 minutes
T2 threshold for neuronal injury risk 30 minutes
Time zero
Witnessed onset time
Last known well time
Early escalation
Resuscitation bay criteria
Ongoing generalized convulsions beyond 5 minutes
Recurrent seizures without baseline recovery
Airway compromise
Team activation
ICU early notification for refractory course
Neurology early notification if available
Anesthesia notification if intubation likely
Monitoring and access
Monitoring bundle
Vital sign frequency
Every 5 minutes during active management
Continuous pulse oximetry
Blood pressure strategy
NIBP cycling every 2 to 3 minutes
Arterial line if vasopressors or anesthetic infusion
Temperature strategy
Active warming if hypothermia
Active cooling if hyperthermia
Vascular access
IV access
Two peripheral lines preferred
Ultrasound guided peripheral if difficult access
IO access
If no IV within 2 minutes
Medication compatibility check for IO route
Immediate treatable causes
Reversible causes
Hypoglycemia
Dextrose therapy if low glucose
Thiamine before dextrose if malnutrition risk
Electrolyte derangements
Sodium disorders
Calcium disorders
Magnesium disorders
Toxicologic causes
Isoniazid concern
Bupropion concern
Tramadol concern
Sympathomimetic toxicity concern
CNS infection concern
Fever
Neck stiffness
Immunocompromised status
Eclampsia concern
Pregnancy beyond 20 weeks
Severe hypertension
Headache or visual symptoms
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.